Skip to main content
SpringerLink
Log in

Outcomes of non-anatomic liver resection for hepatocellular carcinoma in the patients with liver cirrhosis and analysis of prognostic factors

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

In the east countries, patients with hepatocellular carcinoma (HCC) are usually associated with varied degrees of liver cirrhosis, and anatomic resection is therefore limited to use, especially in those with severe liver cirrhosis. This study aims to evaluate the clinical value of non-anatomic resection in HCC patients with cirrhosis.

Methods

Seventy-seven consecutive HCC patients with cirrhosis underwent non-anatomic liver resection in Tongji Hospital from January 2003 to December 2006. The clinical data, severity of liver cirrhosis, and survival rates of these patients were retrospectively evaluated, and the prognostic factors were analyzed.

Results

One-, 2-, and 3-year overall and disease-free survival rates of this cohort of patients were 78%, 68%, 56%, and 66%, 58%, 55%, respectively. The hospital mortality and morbidity were 0% and 24.7%, respectively. The 1-, 2-, and 3-year overall survival rates were 85.7%, 77.1%, and 74.3% in the patients with mild cirrhosis, 81.5%, 63%, and 48.1% in the patients with moderate cirrhosis, and 60.0%, 53.3%, and 26.7% in the patients with severe cirrhosis, respectively. There was a significant difference among the patients with different grades of cirrhosis (P = 0.001). Multivariate and univariate analyses revealed that severity of cirrhosis, tumor diameter larger than 5 cm, and vascular invasion were independent prognostic factors.

Conclusions

Non-anatomic liver resection for HCC could yield comparable outcomes with anatomic resection in the patients with mild cirrhosis or tumors diameter smaller than 5 cm. Severity of cirrhosis is an independent factor worsening long-time survival. Non-anatomic resection is a safe and effective surgical modality in the treatment of HCC patients with cirrhosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Chen XP, Huang ZY (2005) Surgical treatment of hepatocellular carcinoma in China: surgical techniques, indications, and outcomes. Langenbecks Arch Surg 390:259–265

    Article  PubMed  Google Scholar 

  2. Chen XP, Qiu FZ, Wu ZD, Zhang ZW, Huang ZY, Chen YF (2006) Long-term outcome of resection of large hepatocellular carcinoma. Br J Surg 93:600–606

    Article  PubMed  Google Scholar 

  3. Rutkauskas S, Gedrimas V, Pundzius J, Barauskas G, Basevicius A (2006) Clinical and anatomical basis for the classification of the structural parts of liver. Medicina (Kaunas) 42:98–106

    Google Scholar 

  4. El-Serag HB, Mason AC (1999) Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med 340:745–750

    Article  CAS  PubMed  Google Scholar 

  5. Toyosaka A, Okamoto E, Mitsunobu M, Oriyama T, Nakao N, Miura K (1996) Intrahepatic metastases in hepatocellular carcinoma: evidence for spread via the portal vein as an efferent messel. Am J Gastroenterol 91:1610–1615

    CAS  PubMed  Google Scholar 

  6. Tanaka K, Shimada H, Matsumoto C, Matsuo K, Nagano Y, Endo I et al (2008) Anatomic versus limited nonanatomic resection for solitary hepatocellular carcinoma. Surgery 143:607–615

    Article  PubMed  Google Scholar 

  7. Zhou XD, Tang ZY, Yang BH, Lin ZY, Ma ZC, Ye SL et al (2001) Experience of 1000 patients who underwent hepatectomy for small hepatocellular carcinoma. Cancer 91:1479–1486

    Article  CAS  PubMed  Google Scholar 

  8. Makuuchi M, Hasegawa H, Yamazaki S (1985) Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 161:346–350

    CAS  PubMed  Google Scholar 

  9. Cho YB, Lee KU, Lee HW, Cho EH, Yang SH, Cho JY (2007) Anatomic versus non-anatomic resection for small single hepatocellular carcinomas. Hepatogastroenterology 54(78):1766–1769

    PubMed  Google Scholar 

  10. Makuuchi M, Imamura H, Sugawara Y, Takayama T (2002) Progress in surgical treatment of hepatocellular carcinoma. Oncology 62(suppl 1):74–81

    Article  PubMed  Google Scholar 

  11. Imamura H, Matsuyama Y, Miyagawa Y, Ishida K, Shimada R, Miyagawa S et al (1999) Prognostic significance of anatomical resection and des-gamma-carboxy prothrombin in patients with hepatocellular carcinoma. Br J Surg 86(1–2):1032–1038

    Article  CAS  PubMed  Google Scholar 

  12. Yamamoto M, Takasaki K, Ohtsubo T, Katsuragawa H, Fukuda C, Katagiri S (2001) Effectiveness of systematized hepatectomy with Glisson’s pedicle transaction at the hepatic hilus for small nodular hepatocellular carcinoma: retrospective analysis. Surgery 130(1–3):443–448

    Article  CAS  PubMed  Google Scholar 

  13. Yuki K, Hirohashi S, Sakamoto M, Kanai T, Shimosato Y (1990) Growth and spread of hepatocellular carcinoma. A review of 240 consecutive autopsy cases. Cancer 66:2174–2179

    Article  CAS  PubMed  Google Scholar 

  14. Hasegawa K, Kokudo N, Imamura H, Matsuyama Y, Aoki T, Minagawa M et al (2005) Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 242:252–259

    Article  PubMed  Google Scholar 

  15. Kaibori M, Matsui Y, Hijikawa T, Uchida Y, Kwon AH, Kamiyama Y (2006) Comparison of limited and anatomic hepatic resection for hepatocellular carcinoma with hepatitis C. Surgery 139:385–394

    Article  PubMed  Google Scholar 

  16. Yamashita Y, Taketomi A, Itoh S, Kitagawa D, Kayashima H, Harimoto N et al (2007) Longterm favorable results of limited hepatic resections for patients with hepatocellular carcinoma: 20 years of experience. J Am Coll Surg 205:19–26

    Article  PubMed  Google Scholar 

  17. Rigimbeau JM, Kianmanesh R, Farges O, Dondero F, Sauvanet A, Beighiti J (2002) Extent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma. Surgery 131:311–317

    Article  Google Scholar 

  18. Cherqui D, Laurent A, Mocellin N, Tayar C, Luciani A, Van Nhieu JT et al (2009) Liver resection for transplantable hepatocellular carcinoma: long-term survival and role of secondary liver transplantation. Ann Surg 250:738–746

    Article  PubMed  Google Scholar 

  19. de Villa V, Lo CM (2007) Liver transplantation for hepatocellular carcinoma in Asia. Oncologist 12:1321–1331

    Article  PubMed  Google Scholar 

  20. Chen XP, Wu ZD, Huang ZY, Qiu FZ (2005) Use of hepatectomy and splenectomy to treat hepatocellular carcinoma with cirrhosis hypersplenism. Br J Surg 92:334–339

    Article  PubMed  Google Scholar 

  21. Eguchi S, Kanematsu T, Arii S, Okazaki M, Okita K, Omata M et al (2008) Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey. Surgery 143:469–475

    Article  PubMed  Google Scholar 

  22. Kosuge T, Makuuchi M, Takayama T, Yamamoto J, Shimada K, Yamasaki S (1993) Long-term results after resection of hepatocellular carcinoma: experience of 480 cases. Hepatogastroenterology 40:328–332

    CAS  PubMed  Google Scholar 

  23. Suh KS (2005) Systematic hepatectomy for small hepatocelular carcinoma in Korea. J Hepatobiliary Pancreat Surg 12:365–370

    Article  PubMed  Google Scholar 

  24. Ercolani G, Grazi GL, Ravaioli M, Del Gaudio M, Gardini A, Cescon M et al (2003) Liver resection for hepatocellular carcinoma on cirrhosis: univariate and multivariate analysis of risk factors for intrahepatic recurrence. Ann Surg 237:536–543

    Article  PubMed  Google Scholar 

  25. Wakai T, Shirai Y, Yokoyama N, Nagakura S, Hatakeyama K (2003) Hepatitis viral status affects the pattern of intrahepatic recurrence after resection for hepatocellular carcinoma. Eur J Surg Oncol 29:266–271

    Article  CAS  PubMed  Google Scholar 

  26. Poon RT, Fan ST, Ng IO, Wong J (2000) Significance of resection margin in hepatectomy for hepatocellular carcinoma. Ann Surg 231(4):544–551

    Article  CAS  PubMed  Google Scholar 

  27. Shimada K, Sakamoto Y, Esaki M, Kosuge T (2008) Role of the width of the surgical margin in a hepatectomy for small hepatocellular carcinomas eligible for percutaneous local ablative therapy. Am J Surg 195:775–781

    Article  PubMed  Google Scholar 

  28. Shi M, Guo RP, Lin XJ, Zhang YQ, Chen MS, Zhang CQ et al (2007) Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma. Ann Surg 245:36–43

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by funding from the National Natural Science Foundation of China (No. 30772126) and the New Centaury Excellent Talent Foundation of China Ministry of Education (No. NCET-04-0701) to Dr. Zhi-Yong Huang, and by grants from the Chinese Ministry of Public Health for Key Clinical Projects (No. 353, 2007) and the Health Department, the Science & Technology Department of Hubei Province for the Clinical Medicine Research Centre of Hepatic Surgery (2007) to Prof Xiao-ping Chen.

Conflicts of interest

None.

Authors' contributions

Study conception and design, Zhi-yong Huang and Xiao-ping Chen

Acquisition of data, Gen Chen and Rong-yao Cai

Analysis and interpretation of data, Zhi-yong Huang and Xiao-yi Hao

Drafting of manuscript, Zhi-yong Huang, Gen Chen and Yin-feng Zhao

Critical revision of manuscript, Xiao-ping Chen

Author information

Authors and Affiliations

  1. Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Zhi-yong Huang, Gen Chen, Xiao-yi Hao, Rong-yao Cai, Yin-feng Zhao & Xiao-ping Chen

Authors
  1. Zhi-yong Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gen Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiao-yi Hao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rong-yao Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yin-feng Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiao-ping Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xiao-ping Chen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Huang, Zy., Chen, G., Hao, Xy. et al. Outcomes of non-anatomic liver resection for hepatocellular carcinoma in the patients with liver cirrhosis and analysis of prognostic factors. Langenbecks Arch Surg 396, 193–199 (2011). https://doi.org/10.1007/s00423-010-0700-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-010-0700-8

Keywords

Search

Navigation