Is R1 vascular hepatectomy for hepatocellular carcinoma oncologically adequate? Analysis of 327 consecutive patients
| Autor: | Alfonso Terrone, Matteo Donadon, Fabio Procopio, Luca Viganò, Guido Torzilli, Shadya Sara Darwish, Matteo Cimino, Angela Palmisano, D. Del Fabbro |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Carcinoma Hepatocellular Adolescent medicine.medical_treatment Urology 030230 surgery Gastroenterology Disease-Free Survival 03 medical and health sciences Young Adult 0302 clinical medicine Internal medicine Parenchyma Carcinoma Medicine Hepatectomy Humans Prospective Studies Vascular resection Young adult Prospective cohort study Survival rate Aged Aged 80 and over Hepatology business.industry Liver Neoplasms Margins of Excision Middle Aged medicine.disease Prognosis Survival Rate Liver 030220 oncology & carcinogenesis Hepatocellular carcinoma Surgery Female Neoplasm Recurrence Local business Follow-Up Studies |
| Zdroj: | Surgery. 165(5) |
| ISSN: | 1532-7361 |
| Popis: | Background R1 vascular resection for liver tumors was introduced in the early twenty-first century. However, its oncologic adequacy remains controversial. The aim of this study was to determine the oncologic adequacy of R1 vascular hepatectomy in hepatocellular carcinoma patients. Methods A prospective cohort of patients with hepatocellular carcinoma resected between the years 2005 and 2015 was reviewed. R0 was any resection with a minimum 1 mm of negative margin. R1 vascular was any resection with tumor exposure attributable to the detachment from major intrahepatic vessel. R1 parenchymal was any resection with tumor exposure at parenchymal margin. The end points were the calculation of the local recurrence of R0, R1 parenchymal, and R1 vascular hepatectomy and their prognostic significances. Results We analyzed 327 consecutive patients with 532 hepatocellular carcinoma and 448 resection areas. We found that 205 (63%) resulted R0, 56 (17%) resulted R1 parenchymal, 50 (15%) resulted R1 vascular, and 16 (5%) resulted both R1 parenchymal and R1 vascular. After a median follow-up of 33.5 months (range 6.1–107.6), the 5-year overall survival rates were 54%, 30%, 65%, and 36%, respectively for R0, R1 parenchymal, R1 vascular, and R1 parenchymal + R1 vascular (P = .031). Local recurrence rates were 3%, 14%, 4%, and 19%, respectively for R0, R1 parenchymal, R1 vascular, and R1 parenchymal + R1 vascular (P = .001) per patient, and 4%, 4%, 12%, and 18%, respectively for R0, R1 vascular, R1 parenchymal, and R1 parenchymal + R1 vascular (P = .001) per resection area. At multivariate analysis R1 parenchymal and R1 vascular + R1 parenchymal were independent detrimental factors. Conclusion R1 vascular hepatectomy for hepatocellular carcinoma is not associated with increased local recurrence or decreased survival. Thus, detachment of hepatocellular carcinoma from intrahepatic vessels should be considered oncologically adequate. |
| Databáze: | OpenAIRE |
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