Survival Rates Following Hepatoma Resection Continues to Improve

Survival after resection of hepatocellular carcinoma (HCC) has improved significantly over the past 20 years, even in patients with advanced disease, according to a new report.

Researchers at Queen Mary Hospital (Hong Kong, China) and the University of Hong Kong (HKU; China; www.hku.hk) investigated the trend of the posthepatectomy survival outcomes of HCC patients by analysis of a prospective cohort of 1,198 patients between 1989 and 2008. The patients were categorized into two 10-year periods: period 1, before 1999 (totaling 390 patients), and period 2, after 1999 (totaling 808 patients). Patients in group 2 were managed according to a modified protocol and technique established in previous years.

The results showed that the patients in group 2 were older and had a higher incidence of comorbid illness and cirrhosis. Despite this, they had a lower hospital mortality rate, longer 5-year overall survival, and higher disease-free survival rates. An improvement in the overall survival rate was observed in patients with cirrhosis, those undergoing major hepatectomy, and those with tumors of tumor-node-metastasis stages II, IIIA, and IVA. A significant increase in the survival rates was also seen in patients whose tumors were considered transplantable. In all, multivariate analysis showed a significantly more favorable patient survival for hepatectomy in period 2. The study was published early online on February 17, 2011, in the Annals of Surgery.

"Further improvement of results depends on technical refinement to reduce blood loss to the minimum, avoid blood transfusion, preserve liver remnant function, secure tumor-free resection margins, and meticulous perioperative care to reduce complications,” said lead author Prof. Sheung Tat Fan, MD, and colleagues of the Laboratory for Liver Research at HKU and Queen Mary Hospital. "Life-long surveillance for recurrence and prompt treatment are mandatory, but development of more effective local ablation methods are needed to lengthen postrecurrence survival.”


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