Ann Hepatobiliary Pancreat Surg.  2020 Nov;24(4):437-444. 10.14701/ahbps.2020.24.4.437.

Long-term outcomes of liver resection for multiple hepatocellular carcinomas: Single-institution experience with 187 patients

Affiliations
  • 1Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 2Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Abstract

Backgrounds/Aims
Surgical resection for the treatment of multiple hepatocellular carcinomas (HCCs) is controversial. This study aimed to evaluate the clinical and oncological outcomes after liver resection in patients with multiple HCCs.
Methods
Clinicopathological and survival data of 187 patients who underwent curative resection for multiple HCCs between June 2004 and December 2016 at Asan Medical Center, Seoul, South Korea were retrospectively reviewed. The prognostic factors for recurrence and survival were identified using univariate and multivariate analyses.
Results
Of the 187 patients, 153 (81.8%) had two nodules, 23 (12.3%) had three nodules, and 11 (5.9%) had more than three nodules. Multiple tumors were located in the ipsilateral lobe in 163 (87.2%) patients. Anatomical resection, non-anatomical resection, and both types of resections were performed in 81.3%, 8.0%, and 10.7% patients, respectively. Recurrence occurred in 133 (71.1%) patients, and the mean time to recurrence after surgery was 34.2 months. Independent risk factors for tumor recurrence in multivariate analyses were indocyanine green retention rate at 15 min ≥15%, preoperative alpha-fetoprotein level ≥400 ng/ml, and total tumor diameter ≥6 cm. The 1-, 3-, 5-, and 10-year disease-free survival rates were 94.1%, 81.7%, 69.7%, and 39.4%, respectively, and the 1-, 3-, 5-, and 10-year survival rates were 93.5%, 74.2%, 64.9%, and 38.8%, respectively.
Conclusions
Our experience shows that liver resection can be considered a first-line treatment option for selected patients with multiple HCCs who have well-preserved liver function.

Keyword

Carcinoma; Hepatocellular; Hepatectomy; Survival analysis; Multivariate analysis; Multivariate analysis

Figure

  • Fig. 1 (A) Disease-free survival rates and (B) overall survival rates and in patients who underwent liver resection for multiple HCC.


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