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Significance of reduction surgery in multidisciplinary treatment of advanced hepatocellular carcinoma with multiple intrahepatic lesions
Author(s) -
Wakabayashi Hisao,
Ushiyama Takafumi,
Ishimura Ken,
Izuishi Kunihiko,
Karasawa Yukihiko,
Masaki Tsutomu,
Watanabe Seishiro,
Kuriyama Shigeki,
Maeta Hajime
Publication year - 2003
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.10203
Subject(s) - medicine , hepatocellular carcinoma , percutaneous ethanol injection , hepatectomy , proportional hazards model , transcatheter arterial chemoembolization , surgery , adjuvant therapy , hazard ratio , radiation therapy , survival analysis , gastroenterology , chemotherapy , resection , confidence interval , radiofrequency ablation , ablation
Background and Objectives By comparing the survival rates of patients treated with or without surgery, the significance of, and the indication for, reduction surgery in the multidisciplinary treatment of patients with HCC with multiple intrahepatic lesions were examined. Methods In patients with HCC with multiple intrahepatic lesions, cumulative survival rates were determined and compared for 28 patients (group S) who underwent reductive hepatic resection and 43 (group N) who were treated nonsurgically by transcatheter arterial infusion chemotherapy (TAI), transcatheter arterial chemoembolization (TACE), or percutaneous transhepatic ethanol injection therapy. In group S, 20 patients had adjuvant therapy, consisting of ethanol injection therapy or microwave coagulonecrotic therapy for the remaining satellite lesions during hepatectomy, and all patients in this group underwent TAI or TACE postoperatively. The influence of surgery on patient survival was examined by multiple regression analysis using the Cox's hazard model; then, for each prognostic factor, survival rates were obtained and compared between the groups. Results In group S, the 1‐, 3‐, and 5‐year cumulative survival rates were 58.2%, 27.1%, and 21.7%, whereas the corresponding values in group N were 34.3%, 4.7%, and 4.7%, the difference being statistically significant ( P = 0.0239). In group S, the 1‐, 3‐, and 5‐year cumulative survival rates for patients without intraoperative adjuvant therapy were 25%, 0%, and 0%, whereas those for patients with intraoperative adjuvant therapy were 72.7%, 41.3%, and 33.0% ( P = 0.001). Multiple regression analysis showed that hepatic resection, the Child‐Pugh score, and the size of the main tumor affected survival independently. Univariate analysis of differences in the cumulative survival rates between the groups as a function of prognostic factor showed that group S had statistically significant better survival rates than group N in those subgroups of patients who were <60 years old, with HBV infection, with a Child‐Pugh score of 5 or 6, with a main tumor of <5‐cm diameter, with <5 tumors, or without portal thrombi. Conclusions When combined with intraoperative adjuvant therapy for remaining satellite tumors, reduction surgery provided survival benefit for patients with HCC with multiple intrahepatic lesions in those groups of patients selected by criteria determined in this study. J. Surg. Oncol. 2003;82:98–103. © 2003 Wiley‐Liss, Inc.