Results of en bloc resection for hepatocellular carcinoma extending to adjacent organs

Abstract

Results of en bloc resection for hepatocellular carcinoma extending to adjacent organsBackground: To curatively resect hepatocellular carcinoma (HCC) with adjacent organ extension, the combined resection of these organs is inevitable. We analyzed the safety and effectiveness of en bloc resection for HCC extending to adjacent organs. Methods:From December 2002 to May 2006, we compared the surgical outcomes of patients with HCC extending to adjacent organs with those of closely matched, randomly selected patients with HCC without adjacent organ extension. Results:We included 42 patients whose HCC extended to adjacent organs and 126 pa tients whose HCC did not extend to adjacent organs. There was no significant difference in survival, operative morbidity or mortality between the groups. In patients with HCC extending to adjacent organs, histopathological examination of the specimen revealed true tumour invasion in 13 and adhesion in 29 patients. Those with tumour invasion were more likely to have a high incidence of capsule infiltration, microvascular invasion and early intrahepatic recurrence (≤ 1 yr after hepatectomy).The 5-year overall survival of patients with tumour invasion was 11.5%, whereas that of patients with tumour adhesion was 38.1% (p = 0.033). Conclusion:En bloc resection is a safe and effective therapy for HCC extending to adjacent organs. Tumour invasion to adjacent organs exhibits a more aggressive clinical behaviour and is associated with worse survival than tumour adhesion.Contexte : La résection curative d'un carcinome hépatocellulaire ayant envahi des organes adjacents entraîne inévitablement la résection de ces organes. Nous avons analysé l'innocuité et l'efficacité d'une résection radicale dans les cas de carcinome hépatocellulaire s'étant propagé aux organes adjacents. Méthodes :Pour la période allant de décembre 2002 à mai 2006, nous avons comparé les résultats de la chirurgie chez des patients atteints d'un carcinome hépatocellu-laire ayant envahi des organes adjacents aux résultats obtenus chez des patients sélec-tionnés au hasard mais étroitement jumelés, atteints d'un carcinome hépatocellulaire sans propagation aux organes adjacents.Résultats : Nous avons inclus 42 patients dont le carcinome hépatocellulaire s'était propagé aux organes adjacents et 126 patients dont le carcinome hépatocellulaire n'avait pas envahi les organes adjacents. On n'a noté aucune différence significative quant à la survie, la morbidité opératoire ou la mortalité entre les groupes. Chez les patients atteints d'un carcinome hépatocellulaire propagé aux organes adjacents, l'examen histopathologique du spécimen a révélé un réel envahissement tumoral chez 13 patients et des adhésions chez 29 patients. Les patients atteints d'un envahissement tumoral étaient plus susceptibles de présenter une forte incidence d'infiltration capsulaire, d'envahissement microvasculaire et de récurrence intrahépatique précoce (≤ 1 an après l'hépatectomie). La survie globale à 5 ans des patients présentant un envahissement tumoral était ...

Data set for the reporting of intrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma and hepatocellular carcinoma: recommendations from the International Collaboration on Cancer Reporting (ICCR)

“…Published studies have demonstrated that 7–43% of cases where HCC extending to the adjacent organs was suspected during surgery had histological confirmation of tumour invasion . In a more recent study, pre‐operative diagnosis by radiological investigation was confirmed in only 12 (28.5%) cases following surgical resection.…”

“…Perforation of visceral peritoneum or extension to adjacent organ (other than gallbladder) is classified as pT4 with the TNM staging system . The presence of histological tumour invasion of adjacent organs indicates poor prognosis . The most frequent location of HCC extension in other organs is the diaphragm, followed by the right adrenal gland, abdominal wall, colon, stomach and pancreas.…”

Less Fibrotic Burden Differently Affects the Long-Term Outcomes of Hepatocellular Carcinoma after Curative Resection

“…The criteria and detailed procedures for HCC resection corresponded to those previously reported [13] . Curative resection was defined as complete macroscopic removal of the tumor with a microscopically free margin.…”

Hepatocellular carcinoma: Surgeon's view on latest findings and future perspectives

“…Thus, from the surgical point of view, contraindications against liver surgery for HCC might be considered only to be the insufficient future liver remnant after resection. Worse prognostic factors for the outcome are vascular invasion [95] , infiltration of adjacent organs [96] , and presence of lymph node metastases [97] at the time of diagnosis, but represent no contraindications against surgery per se. Resection of HCC with these degrees of tumor extent can be safely resected (when respecting resection limits), and survival after resection is for sure improved when compared to best supportive therapy or palliative chemotherapy approaches.…”