Format

Send to

Choose Destination
Arch Surg. 2008 Jun;143(6):538-43; discussion 543. doi: 10.1001/archsurg.143.6.538.

Treatment of stage IVA hepatocellular carcinoma: should we reappraise the role of surgery?

Author information

1
Department of Hepatobiliary Surgery and Transplantation, Hôpital Cochin, 27 Rue du Faubourg St Jacques, 75014 Paris, France.

Abstract

HYPOTHESIS:

A subset of patients with stage IVA hepatocellular carcinoma (HCC) and preserved liver function may benefit from hepatic resection.

DESIGN:

Retrospective review of a prospectively collected database.

SETTING:

An academic tertiary care hepatobiliary unit.

PATIENTS:

Twenty patients who underwent surgical treatment for stage IVA HCC between July 1998 and October 2004 were identified from the database.

INTERVENTION:

Intraoperative ablation of HCC nodules was combined with resection in 6 patients (30%) to increase resectability. Three patients also underwent resection of extrahepatic tumors. Five patients (25%) had macroscopic invasion of the portal vein and 2 patients (10%) underwent thrombectomy of the vena cava.

MAIN OUTCOME MEASURES:

Intraoperative data, recurrence, and long-term survival rates were analyzed.

RESULTS:

Postoperative mortality and morbidity were 5% and 30%, respectively. The median number of resected tumors per patient was 3, and the median diameter of the largest tumor was 60 mm. With a median follow-up of 23 months, 14 patients (70%) developed recurrence. Treatment of recurrence was possible in 10 patients and included transarterial chemoembolization in 7 patients (35%), of whom 2 (10%) had radiofrequency ablation first, and systemic chemotherapy in 3 patients (15%). Median survival time was 32 months, and the actuarial 1-, 3-, and 5-year survival rates were 73%, 56%, and 45%, respectively.

CONCLUSIONS:

Long-term survival can be achieved using an aggressive surgical approach in select patients with advanced HCC. Patients with stage IVA HCC should be followed up by a multidisciplinary team because recurrence is common and sequential treatments may prolong survival.

PMID:
18559745
DOI:
10.1001/archsurg.143.6.538
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center