A Clinical Study of 15 Long-Term Survivors after Liver Resections for Hepatocellular Carcinomas

Lee, Chun Yong; Nah, Yang Won; Lee, Hyucksang

Abstract

This study was conducted to develop an optimal strategy to achieve long-term survival after a liver resection for a hepatocellular carcinoma by analyzing the actual survival of 54 patients who underwent liver resections at least 5 years ago. The mean age was 50.5 years with a male-to-female ratio of 5 : 1. The positive rates for HBsAg and anti-HCV were 60.4% (32/53) and 10% (1/10), respectively. Seventy-eight percent of the patients had co-existing chronic liver disease. Seventy percent of the patients had either TNM stage III or IV cancer. Fifteen patients (27.8%) survived longer than 5 years after the operation. The median survival time of the 54 patients was 27 months. Prognostic factors of statistical significance were the Child class, gross type and size of the tumor, intrahepatic metastasis, portal vein invasion, serosal invasion, tumor grade, TNM stage, radicality of the operation, cancer recurrence, and disease-free interval. Although the prognosis for the patients with tumors larger than 5 cm was poor, two patients whose tumors were larger than 10 cm with satellite nodules survived longer than 5 years after undergoing complete tumor removal. For the 26 cases with no intrahepatic metastasis, there was no survival difference between the lobectomy group and the segmentectomy/subsegmentectomy group (43% vs. 42%). In those cases with satellite nodules in one segment of the liver, 80% of the lobectomy group lived longer than 5 years while none of the patients in the less-than-lobectomy group survived long-term (p=0.0060). Cancer recurred in 77.8% of the patients. It was the main cause of late death after surgery. Eighty-one percent of the recurrences occurred within 2 years after the operation. Nearly all the recurrences developed in the remnant liver. Among 15 long-term survivors, 6 patients experienced recurrence between the periods of 26 and 76 months after resection. A total of 4 patients (9.5%) out of these 42 patients were subjected to repeat resection for the recurrent tumor. One of these four patients underwent a third resection for a recurrence after the repeat resection. Although the extent of hepatic resection turned out to be a prognostic factor of little significance overall, the recurrence rate of the lobectomy group tended to be lower than that of the less-than-lobectomy group among the subset of long-term survivors (p=0.0572). For long-term survival, a systematic segmentectomy/ subsegmentectomy is adequate for those tumors without intrahepatic metastasis, while the presence of satellite nodules in that segment mandates a standard hepatic lobectomy. For long-term recurrence-free survival, a hepatic lobectomy is probably needed, even for tumors with no intrahepatic metastasis.