Hepatectomy for hepatocellular carcinoma - The surgeon's role in long-termsurvival

Hypothesis: The surgeon can contribute substantially to the long-term survi val rate of patients undergoing hepatectomy for hepatocellular carcinoma (H CC). Design: The long-term survival rate of patients with HCC undergoing hepatec tomy has improved, but the contribution of the surgeon to the improved surv ival rate is unknown. We surveyed 211 consecutive patients undergoing hepat ectomy for HCC. The clinical, operative , and pathological factors were ana lyzed to identify factors that were important in affecting long-term surviv al. Setting: A tertiary referral center. Patients: From April 1989 to December 1995, 211 consecutive patients with H CC 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 an alysis, blood transfusion (relative risk [RR], 1.21; 95% confidence interva l [Cl], 1.05-1.40) and TNM stage (RR, 1.90; 95% Cl, 1.47-2.47) were shown t o be independent prognostic factors in the 5-year disease free survival rat e. The 5-year overall cumulative survival rate was 37%. By Cox regression a nalysis, the preoperative indocyanine green retention value at 15 minutes a fter injection (RR, 1.03; 95% Cl, 1.01-1.06), blood transfusion (RR, 1.191; 95% Cl, 1.078-1.316), tumor rupture (RR, 1.48; 95% Cl, 1.08-2.04), and TNM stage (RR, 1.62; 9596 Cl, 1.27-2.07) were shown to be significant independ ent 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 e, histor y of blood transfusion, and rupture of HCC. Preoperative liver function and tumor staging cannot be altered; however, the surgeon can play an importan t role in improving the prognosis if blood transfusion and iatrogenic tumor rupture can be avoided and if function of the liver remnant can be preserv ed.