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Hepatectomy for hepatocellular carcinoma larger than 10 cm: preoperative risk stratification to prevent futile surgery
- Source :
- HPB. 17:611-623
- Publication Year :
- 2015
- Publisher :
- Elsevier BV, 2015.
-
Abstract
- Objectives Appropriate patient selection is important to achieving good outcomes and obviating futile surgery in patients with huge (≥10 cm) hepatocellular carcinoma (HCC). The aim of this study was to identify independent predictors of futile outcomes, defined as death within 3 months of surgery or within 1 year from early recurrence following hepatectomy for huge HCC. Methods The outcomes of 149 patients with huge HCCs who underwent resection during 1995–2012 were analysed. Multivariate logistic regression analysis was performed to identify preoperative independent predictors of futility. Results Independent predictors of 3‐month mortality (18.1%) were: total bilirubin level >34 μmol/l [ P = 0.0443; odds ratio (OR) 16.470]; platelet count of P = 0.0098; OR 5.039), and the presence of portal vein tumour thrombosis ( P = 0.0041; OR 5.138). The last of these was the sole independent predictor of 1‐year recurrence‐related mortality (17.2%). Rates of recurrence‐related mortality at 3 months and 1 year were, respectively, 6.3% and 7.1% in patients with Barcelona Clinic Liver Cancer (BCLC) stage A disease, 12.5% and 14% in patients with BCLC stage B disease, and 37.8% ( P = 0.0002) and 75% ( P = 0.0002) in patients with BCLC stage C disease. Conclusions According to the present data, among patients submitted to hepatectomy for huge HCC, those with a high bilirubin level, low platelet count and portal vein thrombosis are at higher risk for futile surgery. The presence of portal vein tumour thrombosis should be regarded as a relative contraindication to surgery.
- Subjects :
- Male
Time Factors
Cost-Benefit Analysis
medicine.medical_treatment
Kaplan-Meier Estimate
Risk Factors
Odds Ratio
Aged, 80 and over
Venous Thrombosis
Liver Neoplasms
Gastroenterology
Health Care Costs
Middle Aged
Thrombosis
Tumor Burden
Portal vein thrombosis
Venous thrombosis
Treatment Outcome
Hepatocellular carcinoma
Disease Progression
Female
France
Medical Futility
Adult
medicine.medical_specialty
Carcinoma, Hepatocellular
Adolescent
Risk Assessment
Disease-Free Survival
Decision Support Techniques
Young Adult
Predictive Value of Tests
Biomarkers, Tumor
medicine
Hepatectomy
Humans
Contraindication
Aged
Neoplasm Staging
Hepatology
Platelet Count
business.industry
Patient Selection
Bilirubin
Original Articles
Odds ratio
medicine.disease
BCLC Stage
Surgery
Logistic Models
Multivariate Analysis
Tomography, X-Ray Computed
business
Subjects
Details
- ISSN :
- 1365182X
- Volume :
- 17
- Database :
- OpenAIRE
- Journal :
- HPB
- Accession number :
- edsair.doi.dedup.....5d2b4e6e0e715509478e0d7712c70400