Gastroenterology

Gastroenterology

Volume 134, Issue 7, June 2008, Pages 1908-1916
Gastroenterology

Clinical–Liver, Pancreas, and Biliary Tract
Neither Multiple Tumors Nor Portal Hypertension Are Surgical Contraindications for Hepatocellular Carcinoma

https://doi.org/10.1053/j.gastro.2008.02.091Get rights and content

Background & Aims: The surgical indications for multiple hepatocellular carcinomas (HCCs) and for HCC with portal hypertension (PHT) remain controversial. Methods: We reviewed 434 patients who had undergone an initial resection for HCC and divided them into a multiple (n = 126) or single (n = 308) group according to the number of tumors. We also classified 386 of the patients into a PHT group (n = 136) and a no-PHT (n = 250) group according to whether they had PHT (defined by the presence of esophageal varices or a platelet count of <100,000/μL in association with splenomegaly). Results: Among Child–Pugh class A patients, the overall survival rates in the multiple group were 58% at 5 years, and 56% in the PHT group, which were lower than those in the single group (68%, P = .035) and the no-PHT group (71%, P = .008). Among Child–Pugh class B patients with multiple HCCs, the 5-year overall survival rate was 19%. Multivariate analyses revealed that the presence of multiple tumors was an independent risk factor for postoperative recurrence (relative risk, 1.64; 95% confidence interval, 1.23–2.18; P = .001). A second resection resulted in satisfactory overall survival after the diagnosis of recurrence in the multiple (73% at 3 years) or PHT (73%) groups, as well as in the single (79%) or no PHT (81%) groups. Conclusions: Resection can provide survival benefits even for patients with multiple tumors in a background of Child–Pugh class A cirrhosis, as well as in those with PHT.

Section snippets

Materials and Methods

The study was undertaken in accordance with the Declaration of Helsinki.

Results

The median follow-up period after surgery was 46 months (range, 1–137 mo). Long-term overall survival was significantly poorer in the multiple group than in the single group: the 3-year/5-year overall survival rates were, respectively, 72%/58% in the multiple group and 81%/68% in the single group among patients with Child–Pugh class A cirrhosis (P = .035) and 33%/19% in the multiple group and 72%/45% in the single group among those with Child–Pugh class B cirrhosis (P = .013; Figure 1A). The

Discussion

In our series, liver resection was associated with a 5-year overall survival rate of nearly 60% in patients with HCC who had multiple tumors or PHT (or both), if their liver function remained within the range of Child–Pugh class A. The overall survival of these patients exceeded the currently accepted limit for curative treatment of HCC (a 5-year overall survival of 50%)22, 35 and compared favorably with previous results after resection (24%–60% for patients with multiple HCCs,1, 4, 6, 8, 9, 10

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    Supported by a grant from the Kanae Foundation for Life & Socio-medical Science, a grant from the Public Trust Surgery Research Fund, a grant from the Japanese Clinical Oncology Fund, and a grant from the Public Trust Haraguchi Memorial Cancer Research Fund in Japan, and a Grant-in-aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan (grant 18790955).

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