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Factors associated with early cancer‐related death after curative hepatectomy for solitary small hepatocellular carcinoma without macroscopic vascular invasion
Author(s) -
Sasaki Kazunari,
Matsuda Masamichi,
Ohkura Yu,
Kawamura Yusuke,
Inoue Masafumi,
Hashimoto Masaji,
Ikeda Kenji,
Kumada Hiromitsu,
Watanabe Goro
Publication year - 2014
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.13
Subject(s) - hepatectomy , hepatocellular carcinoma , medicine , perioperative , vascular invasion , liver cancer , carcinoma , oncology , cancer , gastroenterology , pathology , surgery , resection
Background Unexpected early cancer‐related death ( ECRD ) within 2 years due to recurrence after curative hepatectomy for solitary small (<5 cm) hepatocellular carcinoma without macroscopic vascular invasion ( SSHCC ) is occasionally observed. Method A total of 415 patients were enrolled (19 patients with ECRD and 396 patients with non‐ ECRD ) to elucidate the risk factors of ECRD after curative hepatectomy for SSHCC . They were initially compared by limiting variables to preoperative factors to reveal predictors that could enable the modification of primary treatment. Subsequently, the same analysis was performed with all variables, including perioperative and histological factors. Results In the preoperative factors, tumor size > 3 cm and elevation of tumor marker level were independent predictors of ECRD . In the analysis with all variables, excessive intraoperative blood loss, poor differentiation, and microscopic vascular invasion were predictors of ECRD . In the recurrence patterns, 79% of ECRD presented as advanced (four or more lesions) or extra‐hepatic recurrence, whereas these accounted for 18% in the non‐ ECRD . Conclusion Excessive blood loss during the operation and histopathological findings of microscopic vascular invasion and poor differentiation are predictive factors of cancer‐related death within 2 years of a hepatectomy for SSHCC .