Experience of 1000 patients who underwent hepatectomy for small hepatocellular carcinoma

BACKGROUND. Recently, the implementation of screening programs using alpha -fetoprotein (AFP) and ultrasonography in high risk populations has identif ied increasing numbers of patients with small hepatocellular carcinoma (sma ll HCC). The aim of this study was to summarize the authors' experience in patients who underwent hepatectomy for small HCC and the factors that influ ence or improve long term survival. METHODS. The study included 1000 patients who underwent hepatectomy for sma ll HCC (less than or equal to 5 cm) and compared them with 1366 patients wh o underwent hepatectomy for large HCC (> 5 cm) during the same period. A Co x proportional-hazards model was used for multivariate analysis of prognost ic factors. RESULTS. Comparison between patients with small HCC (n = 1000 patients) and patients with large HCC (n = 1366 patients) revealed that those with small HCC had a higher resection rate (93.6% [1000 of 1068 patients] vs. 55.7% [ 1366 of 2451 patients]; P < 0.01), a higher curative resection rate (80.5% [805 of 1000 patients] vs. 60.7% [829 of 1366 patients]; P < 0.01), a lower operative mortality rate (1.5% [15 of 1000 patients] vs. 3.7% [50 of 1366 patients]; P < 0.01), better differentiation of tumor cells (Edmondson Grad e 3-4; 14.9% vs. 20.1%; P < 0.01), a higher incidence of single nodule tumo rs (82.6% vs. 64.4%; P < 0.01), a higher proportion of well encapsulated tu mors (73.3% vs. 46.3%; P < 0.01), a lower incidence of tumor emboli in the portal vein (4.9% vs. 20.8%; P < 0.01), and higher survival rates after und ergoing resection (5 years: 62.7% vs. 37.1%; P < 0.01; 10 years: 46.3% vs. 29.2%; P < 0.01). No significant difference was found between survival afte r undergoing minor resection (n = 949 patients) or lobectomy (n = 51 patien ts) in patients with small HCC (P > 0.05). Reresection for subclinical recu rrence or solitary pulmonary metastasis after small HCC resection was under taken in 84 patients. CONCLUSIONS. Resection is still the modality of first choice for the treatm ent of patients with small HCC. Minor resection instead of lobectomy was th e key to increasing resectability and decreasing operative mortality, and r eresection for subclinical recurrence or solitary pulmonary metastasis was important approach to prolonging survival further. Cancer 2001;91:1479-86. (C) 2001 American Cancer Society.