Prognostic impact of underlying liver fibrosis and cirrhosis after curative resection of hepatocellular carcinoma
Standard
Prognostic impact of underlying liver fibrosis and cirrhosis after curative resection of hepatocellular carcinoma. / Gassmann, Peter; Spieker, Tilmann; Haier, Joerg; Schmidt, Fabian; Mardin, Wolf Arif; Senninger, Norbert.
In: WORLD J SURG, Vol. 34, No. 10, 10.2010, p. 2442-51.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Prognostic impact of underlying liver fibrosis and cirrhosis after curative resection of hepatocellular carcinoma
AU - Gassmann, Peter
AU - Spieker, Tilmann
AU - Haier, Joerg
AU - Schmidt, Fabian
AU - Mardin, Wolf Arif
AU - Senninger, Norbert
PY - 2010/10
Y1 - 2010/10
N2 - BACKGROUND: In the case of hepatocellular carcinoma (HCC), underlying liver pathology may not only determine the feasibility of surgery but may also affect the postsurgical outcome. We report our experience after curative liver resection for HCC in patients with normal liver, liver fibrosis, and liver cirrhosis.METHODS: A total of 72 patients after liver resection with curative intention were analyzed. Histopathologic findings of tumor-unaffected liver tissue were used for retrospective classification: group A (normal liver); group B (liver fibrosis); group C (liver cirrhosis). The groups were compared for differences in short-term surgical results, total survival, and recurrence-free survival.RESULTS: The rate of major complications was 34.7% and did not significantly differ among groups. The overall perioperative mortality rate was 9.7%, with one patient dying in group A and three patients dying in each of the other two groups. Including perioperative mortality, the median overall survival for the whole group was 37.3 months (95% confidence interval 29.3-45.2 months). The respective 1-, 2-, and 5-year survival rates for group A (n = 21) were 86%, 71%, and 50% and for group C (n = 24) 62%, 50%, and 17%. The overall survival of group B (n = 27) was intermediate (log-rank, P = 0.032). The respective recurrence-free survival rates were 76%, 42%, and 20% for group A and 39%, 13%, and 4% for group C, with group B being intermediate (log-rank, P = 0.016).CONCLUSIONS: Our data demonstrate that liver resection in the presence of compensated liver cirrhosis is feasible but associated with a significantly impaired prognosis for overall and recurrence-free survival. The management of cirrhotic patients with compensated liver function and HCC therefore also requires the opportunity for transplantation.
AB - BACKGROUND: In the case of hepatocellular carcinoma (HCC), underlying liver pathology may not only determine the feasibility of surgery but may also affect the postsurgical outcome. We report our experience after curative liver resection for HCC in patients with normal liver, liver fibrosis, and liver cirrhosis.METHODS: A total of 72 patients after liver resection with curative intention were analyzed. Histopathologic findings of tumor-unaffected liver tissue were used for retrospective classification: group A (normal liver); group B (liver fibrosis); group C (liver cirrhosis). The groups were compared for differences in short-term surgical results, total survival, and recurrence-free survival.RESULTS: The rate of major complications was 34.7% and did not significantly differ among groups. The overall perioperative mortality rate was 9.7%, with one patient dying in group A and three patients dying in each of the other two groups. Including perioperative mortality, the median overall survival for the whole group was 37.3 months (95% confidence interval 29.3-45.2 months). The respective 1-, 2-, and 5-year survival rates for group A (n = 21) were 86%, 71%, and 50% and for group C (n = 24) 62%, 50%, and 17%. The overall survival of group B (n = 27) was intermediate (log-rank, P = 0.032). The respective recurrence-free survival rates were 76%, 42%, and 20% for group A and 39%, 13%, and 4% for group C, with group B being intermediate (log-rank, P = 0.016).CONCLUSIONS: Our data demonstrate that liver resection in the presence of compensated liver cirrhosis is feasible but associated with a significantly impaired prognosis for overall and recurrence-free survival. The management of cirrhotic patients with compensated liver function and HCC therefore also requires the opportunity for transplantation.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Carcinoma, Hepatocellular
KW - Feasibility Studies
KW - Female
KW - Hepatectomy
KW - Humans
KW - Liver Cirrhosis
KW - Liver Neoplasms
KW - Male
KW - Middle Aged
KW - Prognosis
KW - Retrospective Studies
KW - Treatment Outcome
KW - Young Adult
U2 - 10.1007/s00268-010-0655-5
DO - 10.1007/s00268-010-0655-5
M3 - SCORING: Journal article
C2 - 20544346
VL - 34
SP - 2442
EP - 2451
JO - WORLD J SURG
JF - WORLD J SURG
SN - 0364-2313
IS - 10
ER -