Influence of coexisting cirrhosis on outcomes after partial hepatic resection for hepatocellular carcinoma fulfilling the Milan criteria: An analysis of 293 patients

• Published in: Surgery 2007-11, Vol.142 (5), p.685-694
• Main Authors: Taura, Kojiro, MD, Ikai, Iwao, MD, Hatano, Etsuro, MD, Yasuchika, Kentaro, MD, Nakajima, Akio, MD, Tada, Masaharu, MD, Seo, Satoru, MD, Machimoto, Takafumi, MD, Uemoto, Shinji, MD
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - surgery; Cause of Death; Comorbidity; Disease-Free Survival; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Hepatectomy - mortality; Hepatitis C, Chronic - mortality; Humans; Liver Cirrhosis - mortality; Liver Cirrhosis - surgery; Liver Neoplasms - mortality; Liver Neoplasms - surgery; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - therapy; Other diseases. Semiology; Prognosis; Surgery; Survival Rate
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2007.05.009

Background For patients with liver cirrhosis and hepatocellular carcinoma (HCC) satisfying the Milan criteria (single tumor ≤5 cm or 2 or 3 tumors ≤3 cm), orthotopic liver transplantation (OLT) is an effective treatment. Nevertheless, it remains controversial whether OLT is the best treatment strategy for patients with resectable HCC. Methods This study included 293 HCC patients (both with and without cirrhosis) oncologically satisfying the Milan criteria who underwent primary and curative liver resection between 1990 and 2003. Results There were 127 noncirrhotic, 129 Child-Pugh A cirrhotic, and 37 Child-Pugh B cirrhotic patients. Five-year survival rates in each population were 81%, 54%, and 28%, respectively. Coexisting cirrhosis, Child-Pugh classification, α-fetoprotein value, tumor burden, and vascular invasion by the tumor were identified as significant prognostic factors. Among these factors, coexisting cirrhosis was the most crucial variable by multivariate analysis. During the initial 3 postoperative years, yearly tumor recurrence rate was 22% in cirrhotic patients and 15% in noncirrhotic patients. In cirrhotic patients, the recurrence rate did not decrease even after three years of tumor-free survival post-resection, whereas in noncirrhotic patients the recurrence rate decreased to 9%. Cirrhosis was associated with a higher probability of recurrence exceeding the Milan criteria. Conclusions Hepatic resection offers an acceptable survival result for HCC patients fulfilling the Milan criteria. Coexisting cirrhosis is associated with higher mortality and recurrence rate, possibly due to multicentric carcinogenesis which limits the efficacy of hepatic resection.