Longterm prognosis after hepatic resection for small hepatocellular carcinoma

BACKGROUND: Treatment of small hepatocellular carcinoma (HCC) remains a critical issue. In addition, the longterm prognosis and prognostic factors of small hepatocellular carcinoma after hepatic resection are not well documented. STUDY DESIGN: The surgical outcomes of 135 consecutive patients with one to three HCCs of diameter less than or equal to3 cm who underwent curative hepatic resection between 1987 and 2001 were reviewed retrospectively. Postresection prognostic factors were evaluated by univariate and multivariate analysis using Cox's proportional hazards model. RESULTS: The overall incidence of postoperative complications was 25%, and three patients had hospital deaths (2%), including one (0.7%) operative death. The mean and median overall survival times, including hospital death after surgery, were 53 months and 43 months, respectively. The 3-, 5-, and 10-year disease-free survival percentages after hepatic resection were 49%, 30%, and 8%, respectively. The 3-, 5-, and 10-year overall survival percentages after hepatic resection were 73%, 55%, and 18%, respectively. Multivariate analysis revealed that age more than 60 years was an independent unfavorable prognostic factor affecting disease-free survival (hazard ratio 1.286, 95% confidence interval 1.107 to 1.863, p = 0.046), and the presence of liver cirrhosis was an independently significant factor of poor overall survival (hazard ratio 2.012, 95% confidence interval 1.049 to 3.861, p = 0.035). The cumulative incidence of postoperative recurrence was 82%. The 5-year overall survival in patients with tumor recurrence undergoing repeat hepatectomy (85%) was significantly greater than in patients without second resection (41%). Six patients (4%) survived longer than 10 years after hepatic resection (four with recurrence and two without recurrence). All four of these patients with postoperative recurrence underwent repeat hepatectomy. CONCLUSIONS: The postresection survival of patients with small hepatocellular carcinoma will differ depending on the presence of liver cirrhosis. Repeat hepatectomy may contribute to the prolongation of survival in such patients with postoperative recurrence. (C) 2004 by the American College of Surgeons.