This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (93)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Surgery  • Surgical Interventions  • Surgical Oncology  • Hepatobiliary Surgery  • Alert me on articles by topic  Social Bookmarking   What's this?

The Surgeon's Role in Long-term Survival

Sheung-Tat Fan, MS, MD, FRCS(Glasg and Edin); Irene O. L. Ng, MD, FRCPath; Ronnie T. P. Poon, MBBS, FRCS(Edin); Chung-Mau Lo, MS, FRCS(Edin), FRACS; Chi-Leung Liu, MBBS, FRCS(Edin); John Wong, PhD, FRACS, FRCS(Edin)

Arch Surg. 1999;134:1124-1130.

Hypothesis  The surgeon can contribute substantially to the long-term survival rate of patients undergoing hepatectomy for hepatocellular carcinoma (HCC).

Design  The long-term survival rate of patients with HCC undergoing hepatectomy has improved, but the contribution of the surgeon to the improved survival rate is unknown. We surveyed 211 consecutive patients undergoing hepatectomy for HCC. The clinical, operative, and pathological factors were analyzed to identify factors that were important in affecting long-term survival.

Setting  A tertiary referral center.

Patients  From April 1989 to December 1995, 211 consecutive patients with HCC underwent 153 major and 58 minor hepatectomies.

Main Outcome Measures  Disease-free and overall cumulative survival rate.

Results  The 5-year disease-free survival rate was 27%. By Cox regression analysis, blood transfusion (relative risk [RR], 1.21; 95% confidence interval [CI], 1.05-1.40) and TNM stage (RR, 1.90; 95% CI, 1.47-2.47) were shown to be independent prognostic factors in the 5-year disease-free survival rate. The 5-year overall cumulative survival rate was 37%. By Cox regression analysis, the preoperative indocyanine green retention value at 15 minutes after injection (RR, 1.03; 95% CI, 1.01-1.06), blood transfusion (RR, 1.191; 95% CI, 1.078-1.316), tumor rupture (RR, 1.48; 95% CI, 1.08-2.04), and TNM stage (RR, 1.62; 95% CI, 1.27-2.07) were shown to be significant independent factors that influenced cumulative survival rate.

Conclusions  The long-term survival of patients with HCC after hepatectomy depends on tumor staging, preoperative hepatic functional reserve, history of blood transfusion, and rupture of HCC. Preoperative liver function and tumor staging cannot be altered; however, the surgeon can play an important role in improving the prognosis if blood transfusion and iatrogenic tumor rupture can be avoided and if function of the liver remnant can be preserved.

From the Departments of Surgery (Drs Fan, Poon, Lo, Liu, and Wong) and Pathology (Dr Ng), the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Risk Factors and Management of Ascites After Liver Resection to Treat Hepatocellular Carcinoma
Ishizawa et al.
Arch Surg 2009;144:46-51.
ABSTRACT | FULL TEXT  

Tumor Size and Operative Risks of Extended Right-Sided Hepatic Resection for Hepatocellular Carcinoma: Implication for Preoperative Portal Vein Embolization
Chik et al.
Arch Surg 2007;142:63-69.
ABSTRACT | FULL TEXT  

Radiofrequency ablation of hepatocellular carcinoma: long-term experience with expandable needle electrodes.
Cabassa et al.
Am. J. Roentgenol. 2006;186:S316-S321.
ABSTRACT | FULL TEXT  

Interleukin-8 Serum Levels in Patients with Hepatocellular Carcinoma: Correlations with Clinicopathological Features and Prognosis
Ren et al.
Clin. Cancer Res. 2003;9:5996-6001.
ABSTRACT | FULL TEXT  

Value of Live Donor Liver Transplantation Experience in Major Hepatectomy for Hepatocellular Carcinoma
Chan et al.
Arch Surg 2003;138:265-271.
ABSTRACT | FULL TEXT  

Hepatic Resection for Bilobar Hepatocellular Carcinoma: Is It Justified?
Liu et al.
Arch Surg 2003;138:100-104.
ABSTRACT | FULL TEXT  

Extended Hepatectomy in Patients With Hepatobiliary Malignancies With and Without Preoperative Portal Vein Embolization
Abdalla et al.
Arch Surg 2002;137:675-681.
ABSTRACT | FULL TEXT  

Sonographically Observed Echogenic Response During Intraoperative Radiofrequency Ablation of Cirrhotic Livers: Pathologic Correlation
Leyendecker et al.
Am. J. Roentgenol. 2002;178:1147-1151.
ABSTRACT | FULL TEXT  

A Prospective Longitudinal Study of Quality of Life After Resection of Hepatocellular Carcinoma
Poon et al.
Arch Surg 2001;136:693-699.
ABSTRACT | FULL TEXT