Advertisement

World Journal of Surgery

, Volume 35, Issue 4, pp 834–841 | Cite as

Selection Criteria for Hepatectomy in Patients with Hepatocellular Carcinoma Classified as Child-Pugh Class B

  • Shintaro Kuroda
  • Hirotaka TashiroEmail author
  • Tsuyoshi Kobayashi
  • Akihiko Oshita
  • Hironobu Amano
  • Hideki Ohdan
Article

Abstract

Background

The appropriate surgical approach for hepatocellular carcinoma (HCC) patients of Child-Pugh class B is unclear. The aim of this study was to clarify the prognostic factors after hepatectomy in Child-Pugh class B patients and to delineate the selection criteria for hepatectomy.

Methods

One hundred fifty patients of Child-Pugh class B who underwent hepatectomy were enrolled in this retrospective study (Hx group). Univariate and multivariate analyses were performed to identify prognostic factors. The prognosis was compared with that of 23 patients of Child-Pugh class B who underwent liver transplantation (LT group).

Results

The overall survival rate of the Hx group was significantly worse than that of the LT group (5-year survival: 36.0 vs. 78.3%, p = 0.001). In multivariate analyses, diabetes mellitus (p = 0.011), preoperative total bilirubin level ≥1.5 mg/dl (p = 0.038), and Child-Pugh score of 8 or 9 (p = 0.038) were independent prognostic factors. Although the overall 5-year survival rate of patients with none of the three adverse prognostic factors was only 50.3%, that of patients with one or more adverse prognostic factors was only 27.2% (p = 0.001).

Conclusions

Hepatectomy may be the optimal initial treatment for HCC patients classified as Child-Pugh class B and without any adverse prognostic factors.

Keywords

Liver Transplantation Liver Cirrhosis Esophageal Varix Milan Criterion Adverse Prognostic Factor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Arii S, Yamaoka Y, Futagawa S et al (2000) Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. The Liver Cancer Study Group of Japan. Hepatology 32:1224–1229PubMedCrossRefGoogle Scholar
  2. 2.
    Pugh RN, Murray-Lyon IM, Dawson JL et al (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649PubMedCrossRefGoogle Scholar
  3. 3.
    Fan ST, Lo CM, Liu CL et al (1999) Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 229:322–330PubMedCrossRefGoogle Scholar
  4. 4.
    Torzilli G, Makuuchi M, Inoue K et al (1999) No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: is there a way? A prospective analysis of our approach. Arch Surg 134:984–992PubMedCrossRefGoogle Scholar
  5. 5.
    Itamoto T, Katayama K, Nakahara H et al (2003) Autologous blood storage before hepatectomy for hepatocellular carcinoma with underlying liver disease. Br J Surg 90:23–28PubMedCrossRefGoogle Scholar
  6. 6.
    Poon RT, Fan ST, Lo CM et al (2002) Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg 235:373–382PubMedCrossRefGoogle Scholar
  7. 7.
    Tang ZY, Yu YQ, Zhou XD (1993) Evolution of surgery in the treatment of hepatocellular carcinoma from the 1950s to the 1990s. Semin Surg Oncol 9:293–297PubMedCrossRefGoogle Scholar
  8. 8.
    Bruix J, Castells A, Bosch J et al (1996) Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology 111:1018–1022PubMedCrossRefGoogle Scholar
  9. 9.
    Llovet JM, Fuster J, Bruix J (1999) Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 30:1434–1440PubMedCrossRefGoogle Scholar
  10. 10.
    Bruix J (1997) Treatment of hepatocellular carcinoma. Hepatology 25:259–262PubMedCrossRefGoogle Scholar
  11. 11.
    Vauthey JN, Klimstra D, Franceschi D et al (1995) Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma. Am J Surg 169:28–34 discussion 34–25PubMedCrossRefGoogle Scholar
  12. 12.
    Sasaki Y, Imaoka S, Masutani S et al (1992) Influence of coexisting cirrhosis on long-term prognosis after surgery in patients with hepatocellular carcinoma. Surgery 112:515–521PubMedGoogle Scholar
  13. 13.
    Yamamoto J, Iwatsuki S, Kosuge T et al (1999) Should hepatomas be treated with hepatic resection or transplantation? Cancer 86:1151–1158PubMedCrossRefGoogle Scholar
  14. 14.
    Bismuth H, Majno PE, Adam R (1999) Liver transplantation for hepatocellular carcinoma. Semin Liver Dis 19:311–322PubMedCrossRefGoogle Scholar
  15. 15.
    Befeler AS, Di Bisceglie AM (2002) Hepatocellular carcinoma: diagnosis and treatment. Gastroenterology 122:1609–1619PubMedCrossRefGoogle Scholar
  16. 16.
    Nagasue N, Kohno H, Tachibana M et al (1999) Prognostic factors after hepatic resection for hepatocellular carcinoma associated with Child-Turcotte class B and C cirrhosis. Ann Surg 229:84–90PubMedCrossRefGoogle Scholar
  17. 17.
    Nakahara H, Itamoto T, Katayama K et al (2005) Indication of hepatectomy for cirrhotic patients with hepatocellular carcinoma classified as Child-Pugh class B. World J Surg 29:734–738PubMedCrossRefGoogle Scholar
  18. 18.
    Ueno S, Tanabe G, Nuruki K et al (2002) Prognosis of hepatocellular carcinoma associated with Child class B and C cirrhosis in relation to treatment: a multivariate analysis of 411 patients at a single center. J Hepatobiliary Pancreat Surg 9:469–477PubMedCrossRefGoogle Scholar
  19. 19.
    Oishi K, Itamoto T, Kobayashi T et al (2009) Hepatectomy for hepatocellular carcinoma in elderly patients aged 75 years or more. J Gastrointest Surg 13:695–701PubMedCrossRefGoogle Scholar
  20. 20.
    Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196PubMedCrossRefGoogle Scholar
  21. 21.
    Belghiti J, Panis Y, Farges O et al (1991) Intrahepatic recurrence after resection of hepatocellular carcinoma complicating cirrhosis. Ann Surg 214:114–117PubMedCrossRefGoogle Scholar
  22. 22.
    Ikeda Y, Shimada M, Hasegawa H et al (1998) Prognosis of hepatocellular carcinoma with diabetes mellitus after hepatic resection. Hepatology 27:1567–1571PubMedCrossRefGoogle Scholar
  23. 23.
    Hassan MM, Hwang LY, Hatten CJ et al (2002) Risk factors for hepatocellular carcinoma: synergism of alcohol with viral hepatitis and diabetes mellitus. Hepatology 36:1206–1213PubMedCrossRefGoogle Scholar
  24. 24.
    Davila JA, Morgan RO, Shaib Y et al (2005) Diabetes increases the risk of hepatocellular carcinoma in the United States: a population based case control study. Gut 54:533–539PubMedCrossRefGoogle Scholar
  25. 25.
    Torisu Y, Ikeda K, Kobayashi M et al (2007) Diabetes mellitus increases the risk of hepatocarcinogenesis in patients with alcoholic cirrhosis: a preliminary report. Hepatol Res 37:517–523PubMedCrossRefGoogle Scholar
  26. 26.
    Hung CH, Wang JH, Hu TH et al (2010) Insulin resistance is associated with hepatocellular carcinoma in chronic hepatitis C infection. World J Gastroenterol 16:2265–2271PubMedCrossRefGoogle Scholar
  27. 27.
    Dellon ES, Shaheen NJ (2005) Diabetes and hepatocellular carcinoma: associations, biologic plausibility, and clinical implications. Gastroenterology 129:1132–1134PubMedCrossRefGoogle Scholar
  28. 28.
    Wolf I, Sadetzki S, Catane R et al (2005) Diabetes mellitus and breast cancer. Lancet Oncol 6:103–111PubMedCrossRefGoogle Scholar
  29. 29.
    Belghiti J, Cortes A, Abdalla EK et al (2003) Resection prior to liver transplantation for hepatocellular carcinoma. Ann Surg 238:885–892 discussion 892–883PubMedCrossRefGoogle Scholar
  30. 30.
    Adam R, Azoulay D, Castaing D et al (2003) Liver resection as a bridge to transplantation for hepatocellular carcinoma on cirrhosis: a reasonable strategy? Ann Surg 238:508–518 discussion 518–509PubMedCrossRefGoogle Scholar
  31. 31.
    Del Gaudio M, Ercolani G, Ravaioli M et al (2008) Liver transplantation for recurrent hepatocellular carcinoma on cirrhosis after liver resection: University of Bologna experience. Am J Transplant 8:1177–1185PubMedCrossRefGoogle Scholar
  32. 32.
    Cherqui D, Laurent A, Mocellin N et al (2009) Liver resection for transplantable hepatocellular carcinoma: long-term survival and role of secondary liver transplantation. Ann Surg 250:738–746PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Shintaro Kuroda
    • 1
  • Hirotaka Tashiro
    • 1
    Email author
  • Tsuyoshi Kobayashi
    • 1
  • Akihiko Oshita
    • 1
  • Hironobu Amano
    • 1
  • Hideki Ohdan
    • 1
  1. 1.Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical SciencesHiroshima UniversityHiroshimaJapan

Personalised recommendations