Journal Mobile Options
Table of Contents
Vol. 21, No. 5-6, 2004
Issue release date: 2004

Good Outcomes after Resection of Large Hepatocellular Carcinoma in the Non-Cirrhotic Liver

Verhoef C. · de Man R.A. · Zondervan P.E. · Eijkemans M.J.C. · Tilanus H.W. · IJzermans J.N.M.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Background: The results of partial liver resection of hepatocellular carcinoma (HCC) in non-cirrhotic livers are not well known. Therefore a retrospective study was conducted. Methods: The medical records of 180 patients with HCC were reviewed. In 40 patients (22%), HCC occurred in a non-cirrhotic liver. A detailed analysis of these patients was performed. The diagnosis HCC was based on imaging and/or percutaneous ultrasound-guided biopsy. A biopsy of the remaining liver and peroperative findings documented the absence of cirrhosis. Results: Twenty-two patients underwent partial liver resection. There was no surgical mortality. The median tumour diameter in the operated patients was 10 cm. Survival rates for operated patients at 1 and 5 years were 96 and 68%, respectively. Significant factors reducing survival were portal vein thrombosis, positive lymph nodes, microscopic vascular invasion and tumour recurrence. Tumour size at the initial moment of diagnosis was not of predictive value. After surgery with curative intent disease-free interval at 1 and 5 years were 86 and 56%, respectively. Conclusion: In selected patients without cirrhosis, HCC can be treated successfully by surgical resection, independent of the tumour diameter, with a 5-year survival rate of 68%.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Simonetti RG, Camma C, Fiorello F, et al: Hepatocellular carcinoma. A worldwide problem and the major risk factors. Dig Dis Sci 1991;36:962–972.
  2. Rutsgi VK: Epidemiology of hepatocellular carcinoma. Ann Int Med 1988;108:390–391.

    External Resources

  3. Ramsey WH, Wu GY: Hepatocellular carcinoma: Update on diagnosis and treatment. Dig Dis 1995;13:81–91.
  4. Fong Y, Sun RL, Jarnagin W, et al: An analysis of 412 cases of hepatocellular carcinoma at a western center. Ann Surg 1999;229:790–800.
  5. Bilimoria MM, Lauwers GY, Dohery DA, et al: Underlying liver disease, not tumor factors, predicts long-term survival after resection of hepatocellular carcinoma. Arch Surg 2001;136:528–533.
  6. Nzeako UC, Goodman ZD, Ishak KG: Hepatocellular carcinoma in cirrhotic and non cirrhotic livers. A clinico-histopathologic study of 804 North American patients. Am J Clin Path 1996;105:65–75.
  7. Trevisani F, D’Intimo PE, Caraceni P, et al: Etiologic factors and clinical presentation of hepatocellular carcinoma: Differences between cirrhotic and noncirrhotic Italian patients. Cancer 1995;75:2220–2232.
  8. Bralet MP, Regimbeau JM, Pineau P, et al: Hepatocellular carcinoma occurring in nonfibrotic liver: Epidemiologic and histopathologic analysis of 80 French cases. Hepatology 2000;32:200–204.
  9. Van Roey G, Fevery J, Van Steenbergen W: Hepatocellular carcinoma in Belgium: Clinical and virological characteristics of 154 consecutive cirrhotic and non-cirrhotic patients. Eur J Gastroenterol Hepatol 2000;12:61–66.
  10. Okuda K, Nakshima T, Kojiro M, et al: Hepatocellular carcinoma without cirrhosis in Japanese patients. Gastroenterology 1989;97:140–146.
  11. Grando-Lemaire, Guettier C, Chevret S, et al: Hepatocellular carcinoma without cirrhosis in the West: Epidemiological factors and histopathology of the non-tumorous liver. Groupe d’Etude et de Traitement du Carcinome Hepatocellulaire. J Hepatol 1999;31:508–513.
  12. Blanc JF, De Ledinghen V, Bernard PH, et al: Increased incidence of HFE C282Y mutations in patients with iron overload and hepatocellular carcinoma developed in non-cirrhotic liver. J Hepatol 2000;32:805–811.
  13. Britto MRC, Thomas LA, Balaratnam N, et al: Hepatocellular carcinoma arising in non-cirrhotic liver in genetic haemochromatosis. Scand J Gastroenterol 2000;35:889–893.
  14. Kondo M, Yamamoto H, Nagano H, et al: Increased expression of COX-2 in nontumor liver tissue is associated with shorter disease-free survival in patients with hepatocellular carcinoma. Clin Cancer Res 1999;5:4005–4012.
  15. Turlin B, Juguet F, Moirand R, et al: Increased liver iron stores in patients with hepatocarcinoma developed on non-cirrhotic liver. Hepatology 1995;22:446–450.
  16. Knodell RG, Ishak KG, Black WC, et al: Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology1981;1:431–435.
  17. Kubicka S, Rudolph KL, Hanke M, et al: Hepatocellular carcinoma in Germany: A retrospective epidemiological study from a low-endemic area. Liver 2000;20:312–318.
  18. Bosch FX: Global epidemiology of hepatocellular carcinoma; in Okuda K, Tabor E (eds): Liver Cancer. New York, Churchill Livingstone, 1997, pp 13–28.
  19. Schotman SN, De Man RA, Stoker J, et al: Subcutaneous seeding of hepatocellular carcinoma after percutaneous needle core biopsy. Gut 1999;45:626–627.
  20. Bismuth H, Chiche L, Castaing D: Surgical treatment of hepatocellular carcinomas in noncirrhotic liver: Experience with 68 liver resections. World J Surg 1995;19:35–41.
  21. Nagasue N, Ono T, Yamanoi A, et al: Prognostic factors and survival after hepatic resection for hepatocellular carcinoma without cirrhosis. Br J Surg 2001;88:515–522.
  22. Smalley SR, Moertel CG, Hilton JF, et al: Hepatoma in the noncirrhotic liver. Cancer 1988;62:1414–1424.
  23. Zhou XD, Tang ZY, Yu YQ, et al: Hepatocellular carcinoma: Some aspects to improve long-term survival. J Surg Oncol 1989;41:256–262.
  24. Farges O, Regimbeau JM, Belghiti J: Aggressive management of recurrence following surgical resection of hepatocellular carcinoma. Hepatogastroenterology 1998;45(suppl 3):1275–1280.

    External Resources

  25. Poon RT, Fan ST, O’Suilleabhain CB, Wong J: Aggressive management of patients with extrahepatic and intrahepatic recurrences of hepatocellular carcinoma by combined resection and locoregional therapy. J Am Coll Surg 2002;195:311–318.
  26. Arii S, Monden K, Niwano M, Furutani M, Mori A, Mizumoto M, et al: Results of surgical treatment for recurrent hepatocellular carcinoma; comparison of outcome among patients with multicentric carcinogenesis, intrahepatic metastasis, and extrahepatic recurrence. J Hepatobiliary Pancreat Surg 1998;5:86–92.
  27. Lo CM, Lai EC, Fan ST, Choi TK, Wong J: Resection for extrahepatic recurrence of hepatocellular carcinoma. Br J Surg 1994;81:1019–1021.
  28. Iwatsuki S, Starzl TE, Sheahan DG, et al: Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg 1991;214:221–228.
  29. Pichlmayr R, Weimann A, Oldhafer KJ, et al: Role of liver transplantation in the treatment of unresectable liver cancer. World J Surg 1995;19:807–813.
  30. Houben KW, McCall JL: Liver transplantation for hepatocellular carcinoma in patients without underlying liver disease: A systematic review. Liver Transpl Surg 1999;5:91–95.
  31. Neuhaus P, Jonas S, Bechstein WO: Hepatoma of the liver, resection or transplantation? Langenbeck’s Arch Surg 2000;385:171–178.
  32. Chiappa A, Zbar A, Audisio RA, et al: Emergency liver resection for ruptured hepatocellular carcinoma complicating cirrhosis. Hepatogastroenterology 1999;46:1145–1150.
  33. Adson MA: Primary hepatocellular cancers: Western experience; in Lumgart LH (ed): Surgery of the Liver and Biliary Tract, ed 2. Edinburgh, Churchill Livingstone, 1988, pp 1153–1165.
  34. Iwatsuki S, Starzl TE: Personal experience with 411 hepatic resections. Ann Surg 1988;208:421–434.
  35. Ringe B, Pichlmayr R, Wittekind C, et al: Surgical treatment of HCC: Experience with liver resection and transplantation in 198 patients. World J Surg 1991;15:270–285.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50