Prognostic Factor Analysis of 200 Consecutive Hepatic Resections for Hepatocellular Carcinoma

PURPOSE: The long-term outcome after liver resection for hepatocellular carcinoma (HCC) is somewhat disappointing because of tumor recurrence. The purposes of this study were to evaluate the prognostic factors and to suggest the data to improve the long-term outcome of hepatic resection for HCC. METHODS: A retrospective survey was carried out in 200 patients undergoing hepatic resection for HCC from April 2001 to June 2004. The various clinicopathologic factors were analysed for the overall survival (OS) and the disease-free survival (DFS) rates by the univariate test (log rank test) and multivariate test (Cox regression model). RESULTS: There were one hospital mortality and 23% morbidity after partial hepatectomy. Intraoperative transfusion was given to 20 patients (10%). Mean follow-up period was 19 months (range, 2-43). The 1-, 2- and 3-year OS rates after hepatic resection for HCC were 90.5%, 86.8% and 76.2% and the 1-, 2- and 3-year DFS rates were 65.5%, 54.3% and 49.4%, respectively. By the univariate analysis for OS, aspartate aminotransferase (AST), Child-Pugh classification, Edmondson-Steiner histologic grade, microvascular invasion, major vessel invasion, alpha-fetoprotein (AFP), TNM stage, transfusion, surgical margin involvement and presence of complication were significant for survival. By the multivariate analysis, Child-Pugh classification, Edmondson-Steiner histologic grade, major vessel invasion and complication were independent risk factors for OS. Whereas viral marker, Child-Pugh classification, microvascular invasion, major vessel invasion, AFP, TNM stage, surgical margin involvement and presence of complication were the significant risk factors for DFS by the univariate analysis, viral marker, microvascular invasion, major vessel invasion, surgical margin involvement and presence of complication were the independent predictive factors of the DFS. CONCLUSION: Hepatic resection for HCC has become safe. To improve the long-term outcome of hepatic resection for HCC, the patients with poor liver function or major vessel invasion should be precluded in hepatic resection, if possible, and adequate surgical margin and avoidance of complication are mandatory.

Clinical Study of Gallbladder Carcinoma Identified after Simple Cholecystectomy as an Initial Operation

PURPOSE: Gallbladder carcinoma (GBC) is a rare neoplasm with poor prognosis. With the introduction and the wide acceptance of laparoscopic surgery, the diagnostic rate of incidental GBC has increased. We report our experience with the reoperated GBC diagnosed after simple cholecystectomy. METHODS: From March 2001 to July 2005, 17 patients with a postoperative diagnosis of GBC after prior simple cholecystectomy were referred to our center for curative reoperation. The types of simple cholecystectomy were open cholecystectomy in 5 cases, and laparoscopic cholecystectomy in 12 cases. The types of reoperation were hepatic wedge resection with lymph node dissection (HWR /(c) LND, n=9), HWR with LND and bile duct resection (HWR /(c) LND and BDR, n=4), right hepatectomy (RH) with LND and BDR (n=1), extended RH with LND, BDR and caudate lobectomy (n=1) and extended left hepatectomy with LND and BDR (n=1). Residual tumor is defined as the tumor tissue detected on reoperation; bile duct, liver, lymph node, lymphatics, vessels and nerves. RESULTS: There is no operative mortality. The median hospital stay was 18.5days (range, 8 - 44 days). The median interval between 1st and 2nd operation was 23.5 days (range, 6 - 44 days). The median operative time was 379 minutes (range, 240-726). Five complications occurred in 4 patients. One patient received intraoperative transfusion. The depth of tumor invasion in 17 patients was T2 in 15, T3 in 1, and T4 in 1. There was no residual tumor in 8 out of 17 patients. In the other 9 patients, the residual tumor was identified after reoperation; liver in 2, lymph node in 7, bile duct in 3, lymphatics in 6, vessels in 3, and nerves in 3. Three patients of 17 patients recurred and 2 patients of them died. In curative reoperation after simple cholecystectomy, the median follow-up length was 14.7 months (1-53 months). One- and two-year survival rates were 90.9%, 79.6%, respectively. Vascular, lymphatic, and neural invasions were the significant risk factors for recurrence by the log-rank test. CONCLUSION: Reoperation of GBC diagnosed after simple cholecystectomy is safe and may be effective. Lymphatic, vascular, and neural invasion may have a dismal effect on the disease-free survival.