Salvage hepatectomy for local recurrence of hepatocellular carcinomas offers survival comparable to that of matched patients who undergo primary hepatectomies
| Autor: | Nobuyoshi Hiraoka, Satoshi Nara, Kazuaki Shimada, Yoji Kishi, Minoru Esaki |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Carcinoma Hepatocellular Time Factors Adolescent medicine.medical_treatment 030230 surgery Subgroup B Gastroenterology Neoplasms Multiple Primary Young Adult 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Overall survival Hepatectomy Humans Child Aged Retrospective Studies Aged 80 and over Salvage Therapy business.industry Incidence (epidemiology) Liver Neoplasms General Medicine Middle Aged HCCS Prognosis medicine.disease Nonsurgical treatment Surgery Survival Rate Oncology Case-Control Studies 030220 oncology & carcinogenesis Hepatocellular carcinoma Female Neoplasm Recurrence Local business |
| Zdroj: | European Journal of Surgical Oncology (EJSO). 43:1076-1082 |
| ISSN: | 0748-7983 |
| Popis: | Background The feasibility of salvage hepatectomy for locally recurrent hepatocellular carcinomas (HCCs) is unclear, especially for patients with viable parts of previously multinodular tumors. Methods We reviewed charts of patients who underwent initial hepatectomies between 2000 and 2014 to select those with local recurrences (LR) after non-surgical treatments. Their postoperative outcomes, including morbidity, recurrence-free survival (RFS), and overall survival (OS) were compared with matched patients who underwent initial hepatectomies for primary HCCs (PR). Their local recurrence patterns were divided into recurrent solitary tumors (Subgroup A); and recurrent parts of multinodular tumors (Subgroup B). Results Among 664 patients, hepatectomy for LR was performed in 62 patients. Matched 59 patients were selected as PR. Clinicopathologic profiles at initial surgery were comparable between the LR and PR groups. Incidence of major morbidity (LR vs. PR, 7% vs. 5%, P = 1.00), 5-year RFS (21% vs. 37%, P = 0.28), and 5-year OS (69% vs. 69%, P = 0.62) were comparable. In the LR group, Subgroup B showed worse 5-year RFS (A vs. B, 29% vs. 0%, P P = 0.01). Postoperative recurrence occurred in 46 patients, but local and extrahepatic recurrence was seen only in 2 patients and 2 patients, respectively. Conclusion Salvage hepatectomy for locally recurrent HCCs is feasible, and results in prognosis comparable with hepatectomy for primary HCCs. Although the risk of postoperative recurrence was high in Subgroup B, rare local recurrence suggests the usefulness of salvaging uncontrolled tumor by nonsurgical treatment. |
| Databáze: | OpenAIRE |
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