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Treatment Strategy to Improve Long-Term Survival for Hepatocellular Carcinoma Smaller than 5 cm: Major Hepatectomy vs Minor Hepatectomy

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Abstract

Background

The extent of hepatectomy for solitary hepatocellular carcinoma (HCC) <5 cm is controversial.

Methods

This is a retrospective review of patients with solitary HCC <5 cm, who underwent liver resection in a tertiary referral centre in Hong Kong between January 1989 and December 2009. Baseline demographics, liver function, peri-operative outcomes, and overall survival were compared.

Results

A total of 348 cirrhotic patients with a solitary HCC <5 cm underwent either major hepatectomy (n = 93) or minor hepatectomy (n = 255). Child-Pugh status did not differ, 98.9 vs. 96.1 % (p = 0.319); all patients who underwent major and minor hepatectomy were classified as Child-Pugh status A. Patients who underwent major hepatectomy had a larger median tumor size (4.0 vs. 2.5 cm, p < 0.001) and they also had more advanced stage of disease (stage I/II/IIIa: 10.8/55.9/33.3 vs. 26.7/52.9/20.4 %, p = 0.002). Median operative time for major hepatectomy was significantly longer (415 vs. 248 min, p < 0.001) and entailed greater blood loss (0.9 vs. 0.5 l, p < 0.001). Despite larger tumor size and more advanced stage of disease in the major hepatectomy group, hospital mortality (5.4 vs. 2.0 %, p = 0.185), complication rates (30.1 vs. 23.1 %, p = 0.234), and transfusion rate (10.8 vs. 11.4 %, p = 0.862) were the same between the two groups. Overall survival was significantly better for those who underwent major hepatectomy, with a median survival of 147.5 vs. 92.1 months (p = 0.043), and they had a better 5- and 10-year disease-free survival rate (57.3 vs. 40.2, 38.1 vs. 18.9 %, p = 0.003). In subgroup analysis, the 10-year survival for patients with stage II HCC and tumor <5 cm was 68.6 vs. 36.6 % in those who received minor hepatectomy alone (p = 0.027).

Conclusions

Major hepatectomy provided better long-term survival benefit in patients with HCC <5 cm, particularly in those with stage II disease.

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Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Department of Surgery Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong S.A.R, China

    Tiffany Cho Lam Wong, Tan To Cheung, Kenneth S. H. Chok, Albert C. Y. Chan, Wing Chiu Dai, See Ching Chan, Ronnie T. P. Poon & Chung Mau Lo

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  1. Tiffany Cho Lam Wong
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  2. Tan To Cheung
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  3. Kenneth S. H. Chok
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  4. Albert C. Y. Chan
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  8. Chung Mau Lo
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Correspondence to Tan To Cheung.

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Wong, T.C.L., Cheung, T.T., Chok, K.S.H. et al. Treatment Strategy to Improve Long-Term Survival for Hepatocellular Carcinoma Smaller than 5 cm: Major Hepatectomy vs Minor Hepatectomy. World J Surg 38, 2386–2394 (2014). https://doi.org/10.1007/s00268-014-2601-4

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  • DOI: https://doi.org/10.1007/s00268-014-2601-4

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