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Recurrence Patterns After Hepatectomy of Hepatocellular Carcinoma: Implication of Milan Criteria Utilization

  • Hepatobiliary and Pancreatic Tumors
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Abstract

Background

Bridge hepatectomy followed by salvage liver transplantation has been proposed for patients with hepatocellular carcinoma (HCC) and preserved liver function.

Methods

Data were prospectively collected for 501 consecutive patients who underwent curative primary hepatectomy for HCC between 1990 and 2006. Patient survival, disease-free survival (DFS), recurrence patterns, and risk factors were analyzed in patients classified according to the Milan criteria.

Results

Patients were divided into two groups on the basis of whether their disease was within the Milan criteria (group 1, n = 321) or not (group 2, n = 180). Group 1 patient survival and DFS rates were 73.6% and 40.6% at 5 years. Recurrence was observed in 160 group 1 patients (49.8%); in 42 (26.3%) of these 160 patients, the recurrence exceeded the Milan criteria. No recurrence was noted in 145 group 1 patients (45.2%). Group 2 patient survival and DFS rates were 52.2% and 23.2%, respectively, at 5 years. Recurrence was noted in 116 patients (64.4%); recurrence in 58 (50.0%) of these patients was within the Milan criteria. In group 2, no recurrence was noted in 55 patients (30.6%). In group 1, indocyanine green retention rate at 15 minutes of >15%, nonanatomical resection, and multiple tumors were statistically significant risk factors for survival; 10-year patient survival was 78.5% for patients with no risk factors and 64.9% for patients with a single risk factor.

Conclusions

The Milan criteria should be used to recommend hepatectomy for patients with HCC; however, it is important to consider the high recurrence rate after hepatectomy and the possible requirement of salvage transplantation.

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Acknowledgments

We thank the staff of General Surgery, Graduate School of Medicine, Hokkaido University, for their cooperation, and Nancy Ehrlich Lapid for the editorial review.

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Authors and Affiliations

  1. Department of General Surgery, Hokkaido University Graduate School of Medicine, Kita-ku, Hokkaido, Sapporo, Japan

    Toshiya Kamiyama MD, Kazuaki Nakanishi MD, Hideki Yokoo MD, Hirofumi Kamachi MD, Munenori Tahara MD, Tsuyoshi Shimamura MD & Satoru Todo MD, FACS

  2. Department of Organ Transplantation and Regenerative Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan

    Tomomi Suzuki MD & Hiroyuki Furukawa MD, FACS

  3. Department of Health Sciences, School of Medicine, Hokkaido University, Hokkaido, Japan

    Michiaki Matsushita MD

Authors
  1. Toshiya Kamiyama MD
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  2. Kazuaki Nakanishi MD
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  3. Hideki Yokoo MD
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  4. Hirofumi Kamachi MD
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  5. Munenori Tahara MD
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  6. Tomomi Suzuki MD
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  7. Tsuyoshi Shimamura MD
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  8. Hiroyuki Furukawa MD, FACS
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  9. Michiaki Matsushita MD
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  10. Satoru Todo MD, FACS
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Corresponding author

Correspondence to Toshiya Kamiyama MD.

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Kamiyama, T., Nakanishi, K., Yokoo, H. et al. Recurrence Patterns After Hepatectomy of Hepatocellular Carcinoma: Implication of Milan Criteria Utilization. Ann Surg Oncol 16, 1560–1571 (2009). https://doi.org/10.1245/s10434-009-0407-7

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  • DOI: https://doi.org/10.1245/s10434-009-0407-7

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