Survival and recurrence after hepatic resection of 386 consecutive patients with hepatocellular carcinoma

Background: Although hepatic resection is one of the most effective treatme nts for hepatocellular carcinoma (HCC), the longterm results of hepatic res ection of this malignancy are far from satisfactory. The potential benefits of hepatectomy for patients with HCC have not been fully delineated. This study aimed to identify surgical outcomes of 386 consecutive patients with HCC undergoing hepatic resection. Study Design: The retrospective study looked at records of 293 men and 93 w omen. The mean age was 63.2 years. Preoperative transarterial chemoemboliza ton and portal vein embolization were performed in 138 patients (35.8%) and 8 patients (2.1%), respectively. Sixty-two patients (16.1%) had major hepa tectomy and the other 324 (83.9%) had minor hepatectomy. Thirty-seven of 38 6 patients (9.6%) had a noncurative operation. Results: The 30-day (operative) mortality rate was 4.1%, and there were 11 additional late deaths (2.9%). Two hundred fourteen of 327 patients (65.4%) had recurrence after curative resection. Unfavorable factors for survival and recurrence were resection between 1983 and 1990, Child class B or C, ci rrhosis, a high value of indocyanine green retention-15, a large amount of intraoperative blood loss, stage ni disease, positive surgical margin, vasc ular invasion, and postoperative complications. Preoperative transarterial chemoembolization increased the recurrence rate and showed no contribution to prognosis. Currently, 106 patients (27.5%) are alive: 7 (1.8%) after mor e than 10 years and 43 (11.1%) after more than 5 years. Mean and median ove rall survivals after operation were 38 months and 29 months, respectively. The 5-year and 10-year overall or disease-free survival rates after hepatic resection were 34.4% arid 10.5% or 23.3% and 7.8%, respectively. Conclusions: The longterm survival rate after operation remains unsatisfact ory mainly because of the high recurrence rate. Preoperative transarterial chemoembolization should be avoided because of a high risk of postoperative recurrence. Treatment strategies for recurrent HCC may play an important r ole in achieving better prognosis after operation, especially in patients w ith more than Child class B, cirrhosis, high values of indocyanine green re tention-15, massive intraoperative blood loss, stage IV disease, positive s urgical margin, vascular invasion, and postoperative complications. (J Am C oll Surg 2000;191:381-388. (C) 2000 by the American College of Surgeons).