Hepatectomy for hepatocellular carcinoma larger than 10 cm: preoperative risk stratification to prevent futile surgery. Issue 7 (16th May 2015)

• Record Type: Journal Article
• Authors: Lim, Chetana; Compagnon, Philippe; Sebagh, Mylène; Salloum, Chady; Calderaro, Julien; Luciani, Alain; Pascal, Gérard; Laurent, Alexis; Levesque, Eric; Maggi, Umberto; Feray, Cyrille; Cherqui, Daniel; Castaing, Denis; Azoulay, Daniel
• Is Part Of: HPB. Volume 17:Issue 7(2015:Jul.)
• Page Start: 611
• Page End: 623
• Publication Date: 2015-05-16
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12416
• Languages: English
• ISSNs: 1365-182X

Abstract

<abstract abstract-type="main" id="hpb12416-abs-0001"> <title>Abstract</title> <sec id="hpb12416-sec-0001" sec-type="section"> <title>Objectives</title> <p>Appropriate patient selection is important to achieving good outcomes and obviating futile surgery in patients with huge (≥10 cm) hepatocellular carcinoma (HCC). The aim of this study was to identify independent predictors of futile outcomes, defined as death within 3 months of surgery or within 1 year from early recurrence following hepatectomy for huge HCC.</p> </sec> <sec id="hpb12416-sec-0002" sec-type="section"> <title>Methods</title> <p>The outcomes of 149 patients with huge HCCs who underwent resection during 1995–2012 were analysed. Multivariate logistic regression analysis was performed to identify preoperative independent predictors of futility.</p> </sec> <sec id="hpb12416-sec-0003" sec-type="section"> <title>Results</title> <p>Independent predictors of 3‐month mortality (18.1%) were: total bilirubin level >34 μmol/l [<italic>P </italic>= 0.0443; odds ratio (OR) 16.470]; platelet count of <150 000 cells/ml (<italic>P</italic> = 0.0098; OR 5.039), and the presence of portal vein tumour thrombosis (<italic>P</italic> = 0.0041; OR 5.138). The last of these was the sole independent predictor of 1‐year recurrence‐related mortality (17.2%). Rates of recurrence‐related mortality at 3 months and 1 year were, respectively, 6.3% and 7.1% in patients with Barcelona Clinic Liver Cancer (BCLC) stage A disease, 12.5% and 14% in patients with BCLC stage B disease, and 37.8% (<italic>P </italic>= 0.0002) and 75% (<italic>P </italic>= 0.0002) in patients with BCLC stage C disease.</p> </sec> <sec id="hpb12416-sec-0004" sec-type="section"> <title>Conclusions</title> <p>According to the present data, among patients submitted to hepatectomy for huge HCC, those with a high bilirubin level, low platelet count and portal vein thrombosis are at higher risk for futile surgery. The presence of portal vein tumour thrombosis should be regarded as a relative contraindication to surgery.</p> </sec> </abstract>