Chirica M et al. - Long-term survival can be achieved using an aggressive surgical approach in select patients with advanced hepatocellular carcinoma (HCC). Methods
Hypotheisis for this study was that a subset of pts with stage IVA HCC and preserved liver function may benefit from hepatic resection
Retrospective review of a prospectively collected database
20 pts who underwent surgical treatment for stage IVA HCC were identified from the database
Intraoperative ablation of HCC nodules was combined with resection in 6 patients (30%)
3 pts also underwent resection of extrahepatic tumors
5 pts (25%) had macroscopic invasion of the portal vein; 2 pts (10%) underwent thrombectomy of the vena cava
Intraoperative data, recurrence, and long-term survival rates were analyzed
Results
Postoperative mortality and morbidity were 5% and 30%, respectively
The median number of resected tumors/patient: 3; median diameter of the largest tumor: 60 mm
With a median f/u of 23 mos, 70% of pts developed recurrence
Treatment of recurrence was possible in 10 pts and included transarterial chemoembolization in 35% pts
10% of these pts had radiofrequency ablation first, and systemic chemotherapy in 15%
Median survival time was 32 mos
1-, 3-, and 5-yr survival rates were 73%, 56%, and 45%, respectively
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