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KMID : 0870420080120040245
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2008 Volume.12 No. 4 p.245 ~ p.253
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Single Center Experience (Ten Years) with Surgical Resection for Treating Hepatocellular Carcinoma - Strategies for improving the long-term survival after resection
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Han Dai-Hoon
Kang Chang-Moo
Choi Gi-Hong
Kim Kyung-Sik
Choi Jin-Sub
Lee Woo-Jung
Park Young-Nyun
Chon Chae-Yoon
Park Jun-Yong
Han Kwang-Hyub
Kim Do-Young
Choi Sae-Byeol
Kim Dong-Hyun
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Abstract
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Purpose: Although surgical resection is the most effective treatment for hepatocellular 4 carcinoma (HCC), high recurrence after resection is a major challenging problem. We attempted to determine the optimal strategies for improving the long-term surgical outcome through the review of our 10 years’ experience with surgically treating HCC.
Methods: We retrospectively reviewed 497 patients who received curative resection at the Yonsei University Health System from January 1996 to August 2006.
Results: The 5 year disease-free rate and the overall survival rate after curative resection were 45.0% and 63.9%, respectively. Of the 497 patients, 491 (98.8%) were Child-Pugh A and 107 (56.3%) were diagnosed with liver cirrhosis. The postoperative complication and mortality rates were 28.6% and 1.8%, respectively. Of the 243 recurrent patients, 184 (75.7%) were diagnosed with intrahepatic recurrence alone. Of these intrahepatic recurrent patients, 169 (91.9%) received active treatment, including transplantation (n=7), re-resection (n=12), local ablation therapy (n=18) and transarterial chemoembolization (n=132). Multivariate analysis revealed that perioperative transfusion, a satellite nodule, the pathologic TNM stage, the Edmondsons-Steiner grade, the serum alkaline phosphatase (ALP) and aspartate aminotransferase levels and cirrhosis were associated with disease free survival, and perioperative transfusion, a satellite nodule, macroscopic vascular invasion, the Edmondsons-Steiner grade, the ALP and serum albumin levels and the platelet count were related with overall survival after resection.
Conclusions: The long-term surgical outcome of HCC can be further improved by proper patient selection, delicately performed surgery and administering postoperative adjuvant therapy for patients with a high risk of recurrence. Early diagnosis and aggressive treatment are needed to treat the recurrence.
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KEYWORD
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hepatocellular carcinoma, curative resection, long-term outcome
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