The role of hepatic resection in patients with hepatocellular carcinoma and invasion of a main portal or hepatic vein branch is controversial.
Dr Vauthey and colleagues evaluated the efficacy of hepatic resection and the factors affecting survival after resection in such patients.
The research team reviewed the records of 102 patients who underwent resection for hepatocellular carcinoma with major vascular invasion between 1984 and 1999.
Prognostic factors were evaluated by univariate and multivariate analysis.
The researchers included included 87 men and 15 women with a median age of 59 years.
|Patients who derive long-term benefit from resection have no or minimal underlying fibrosis|
The team reported that the perioperative mortality rate was 6% and the median survival was 11 months.
The investigators found that the 1, 3, and 5 year survival rates were 45%, 17%, and 10% with the longest-living survivor still alive at 15 years.
The research team showed that absence of moderate to severe fibrosis and absence of high nuclear grade were both associated with a better 5 year survival rate of 23 % versus 5 %, and 21 % versus 9 %, respectively.
On using multivariate analysis, the team noted that moderate to severe fibrosis remained a significant predictor of survival for both short-term of 6 months and long-term of more than 6 months.
Dr Vauthey’s team concludes, “Hepatic resection for hepatocellular carcinoma with major vascular invasion is associated with a median survival, exceeding historical survival in patients not treated surgically.”
“Patients with hepatocellular carcinoma and major vascular invasion who derive long-term benefit from resection have no or minimal underlying fibrosis.”