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SURGICAL MANAGEMENT OF LARGE HEPATOCELLULAR CARCINOMA: THE FIRST SINGLE-CENTER STUDY FROM WESTERN INDIA
BACKGROUND: Majority of patients with large size HCC (>10 cm) are not offered surgery as per Barcelona Clinic Liver Cancer (BCLC) criteria and hence, their outcomes are not well studied, especially from India, owing to a lower incidence. AIM: To analyze outcomes of surgery for large HCCs. METHODS...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Colégio Brasileiro de Cirurgia Digestiva
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7682151/ https://www.ncbi.nlm.nih.gov/pubmed/33237158 http://dx.doi.org/10.1590/0102-672020190001e1505 |
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author | WAGLE, Prasad NARKHEDE, Rajvilas DESAI, Gunjan PANDE, Prasad KULKARNI, D R VARTY, Paresh |
author_facet | WAGLE, Prasad NARKHEDE, Rajvilas DESAI, Gunjan PANDE, Prasad KULKARNI, D R VARTY, Paresh |
author_sort | WAGLE, Prasad |
collection | PubMed |
description | BACKGROUND: Majority of patients with large size HCC (>10 cm) are not offered surgery as per Barcelona Clinic Liver Cancer (BCLC) criteria and hence, their outcomes are not well studied, especially from India, owing to a lower incidence. AIM: To analyze outcomes of surgery for large HCCs. METHODS: This retrospective observational study included all patients who underwent surgery for large HCC from January 2007 to December 2017. The entire perioperative and follow up data was collected and analyzed. RESULTS: Nineteen patients were included. Ten were non-cirrhotic; 16 were BCLC grade A; one BCLC grade B; and two were BCLC C. Two cirrhotic and three non-cirrhotic underwent preoperative sequential trans-arterial chemoembolization and portal vein embolization. Right hepatectomy was the most commonly done procedure. The postoperative 30-day mortality rate was 5% (1/19). Wound infection and postoperative ascites was seen in seven patients each. Postoperative liver failure was seen in five. Two cirrhotic and two non-cirrhotic patients had postoperative bile leak. The hospital stay was 11.9±5.4 days (median 12 days). Vascular invasion was present in four cirrhotic and five non-cirrhotic patients. The median follow-up was 32 months. Five patients died in the follow-up period. Seven had recurrence and median recurrence free survival was 18 months. The cumulative recurrence free survival was 88% and 54%, whereas the cumulative overall survival was 94% and 73% at one and three years respectively. Both were better in non-cirrhotic; however, the difference was not statistically significant. The recurrence free survival was better in patients without vascular invasion and the difference was statistically significant (p=0.011). CONCLUSION: Large HCC is not a contraindication for surgery. Vascular invasion if present, adversely affects survival. Proper case selection can provide the most favorable survival with minimal morbidity. |
format | Online Article Text |
id | pubmed-7682151 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Colégio Brasileiro de Cirurgia Digestiva |
record_format | MEDLINE/PubMed |
spelling | pubmed-76821512020-11-25 SURGICAL MANAGEMENT OF LARGE HEPATOCELLULAR CARCINOMA: THE FIRST SINGLE-CENTER STUDY FROM WESTERN INDIA WAGLE, Prasad NARKHEDE, Rajvilas DESAI, Gunjan PANDE, Prasad KULKARNI, D R VARTY, Paresh Arq Bras Cir Dig Original Article BACKGROUND: Majority of patients with large size HCC (>10 cm) are not offered surgery as per Barcelona Clinic Liver Cancer (BCLC) criteria and hence, their outcomes are not well studied, especially from India, owing to a lower incidence. AIM: To analyze outcomes of surgery for large HCCs. METHODS: This retrospective observational study included all patients who underwent surgery for large HCC from January 2007 to December 2017. The entire perioperative and follow up data was collected and analyzed. RESULTS: Nineteen patients were included. Ten were non-cirrhotic; 16 were BCLC grade A; one BCLC grade B; and two were BCLC C. Two cirrhotic and three non-cirrhotic underwent preoperative sequential trans-arterial chemoembolization and portal vein embolization. Right hepatectomy was the most commonly done procedure. The postoperative 30-day mortality rate was 5% (1/19). Wound infection and postoperative ascites was seen in seven patients each. Postoperative liver failure was seen in five. Two cirrhotic and two non-cirrhotic patients had postoperative bile leak. The hospital stay was 11.9±5.4 days (median 12 days). Vascular invasion was present in four cirrhotic and five non-cirrhotic patients. The median follow-up was 32 months. Five patients died in the follow-up period. Seven had recurrence and median recurrence free survival was 18 months. The cumulative recurrence free survival was 88% and 54%, whereas the cumulative overall survival was 94% and 73% at one and three years respectively. Both were better in non-cirrhotic; however, the difference was not statistically significant. The recurrence free survival was better in patients without vascular invasion and the difference was statistically significant (p=0.011). CONCLUSION: Large HCC is not a contraindication for surgery. Vascular invasion if present, adversely affects survival. Proper case selection can provide the most favorable survival with minimal morbidity. Colégio Brasileiro de Cirurgia Digestiva 2020-11-20 /pmc/articles/PMC7682151/ /pubmed/33237158 http://dx.doi.org/10.1590/0102-672020190001e1505 Text en https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License |
spellingShingle | Original Article WAGLE, Prasad NARKHEDE, Rajvilas DESAI, Gunjan PANDE, Prasad KULKARNI, D R VARTY, Paresh SURGICAL MANAGEMENT OF LARGE HEPATOCELLULAR CARCINOMA: THE FIRST SINGLE-CENTER STUDY FROM WESTERN INDIA |
title | SURGICAL MANAGEMENT OF LARGE HEPATOCELLULAR CARCINOMA: THE FIRST
SINGLE-CENTER STUDY FROM WESTERN INDIA |
title_full | SURGICAL MANAGEMENT OF LARGE HEPATOCELLULAR CARCINOMA: THE FIRST
SINGLE-CENTER STUDY FROM WESTERN INDIA |
title_fullStr | SURGICAL MANAGEMENT OF LARGE HEPATOCELLULAR CARCINOMA: THE FIRST
SINGLE-CENTER STUDY FROM WESTERN INDIA |
title_full_unstemmed | SURGICAL MANAGEMENT OF LARGE HEPATOCELLULAR CARCINOMA: THE FIRST
SINGLE-CENTER STUDY FROM WESTERN INDIA |
title_short | SURGICAL MANAGEMENT OF LARGE HEPATOCELLULAR CARCINOMA: THE FIRST
SINGLE-CENTER STUDY FROM WESTERN INDIA |
title_sort | surgical management of large hepatocellular carcinoma: the first
single-center study from western india |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7682151/ https://www.ncbi.nlm.nih.gov/pubmed/33237158 http://dx.doi.org/10.1590/0102-672020190001e1505 |
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