LIVER, PANCREAS AND BILIARY TRACT: Original Articles

Recurrent Hepatocellular Carcinoma and Poorer Overall Survival in Patients Undergoing Left-sided Compared With Right-sided Partial Hepatectomy

Valenzuela, Antonia MD^*; Ha, Nghiem B. BS^*; Gallo, Amy MD^†; Bonham, Clark MD^†; Ahmed, Aijaz MD^*; Melcher, Marc MD, PhD^†; Kim, Lily H. BA^*; Esquivel, Carlos MD, PhD^†; Concepcion, Waldo MD^†; Ayoub, Walid S. MD^*; Lutchman, Glen A. MD, MS^*; Daugherty, Tami MD^*; Nguyen, Mindie H. MD, MAS^*

Author Information

^*Division of GI and Hepatology

^†Department of Surgery, Stanford University Medical Center, Palo Alto, CA

A.V.: study concept and design, data acquisition, data analysis, and interpretation and drafting of the manuscript. N.B.H.: study concept and design, data analysis and interpretation, critical review of manuscript. A.G.: study concept and design, data acquisition, data interpretation, and critical review of manuscript. C.B. and A.A.: study concept and design, data interpretation, and critical review of manuscript. M.M., C.E., W.C., T.D., W.S.A., and G.A.L.: data interpretation and critical review of manuscript. L.H.K.: data acquisition, data interpretation, and critical review of manuscript. M.H.N.: study concept and design, data acquisition, data analysis and interpretation, critical revision of the manuscript.

A.V. reports been supported by a scholarship from the Chilean Government (Becas Chile/CONICYT).

The authors declare that they have nothing to disclose.

Reprints: Mindie H. Nguyen, MD, MAS, 750 Welch Road, Suite 210, Palo Alto, CA 94304 (e-mail: [email protected]).

Received August 23, 2013

Accepted March 14, 2014

Journal of Clinical Gastroenterology 49(2):p 158-164, February 2015. | DOI: 10.1097/MCG.0000000000000144

Abstract

Goals:

We aimed to determine the incidence and predictors of recurrent hepatocellular carcinoma (HCC) after partial hepatectomy.

Background:

Liver transplantation is the preferred treatment for selected patients with HCC, but access to donor organs is limited. Partial hepatectomy is another accepted treatment option; however, postoperative recurrence is frequently observed.

Methods:

This is a retrospective cohort study of 107 consecutive patients who underwent partial hepatectomy for HCC between January 1993 and February 2011 at a US University Medical Center. Study endpoints were recurrent HCC, death, loss to follow-up, or last visit without HCC.

Results:

The study cohort was 78% male with a median age of 61 years and 59% Asians. A total of 50 patients developed recurrent HCC (46.7%) after a median follow-up of 12 (1 to 69) months postresection. Recurrent HCC was significantly higher in patients with left-sided resection (41% at year 1, 54% at year 2, 62% at year 3, 81% at year 4, and 90% at year 5) compared with right-sided resection (18% at year 1, 34% at year 2, 36% at year 3, 44% at year 4, and 72% at year 5). In multivariate Cox proportional hazards model also inclusive of anatomic resection and TNM stage 3/4, left-sided resection was significantly associated with increased HCC recurrence (hazard ratio, 2.13; P=0.02; 95% confidence interval, 1.08-4.2) compared with right-sided resection.

Conclusions:

HCC recurrence rate is higher among those undergoing left-sided resection: 54% at year 2 and 81% at year 4. Liver transplantation should be considered in patients who are at high risk for recurrence.

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Recurrent Hepatocellular Carcinoma and Poorer Overall Survival in Patients Undergoing Left-sided Compared With Right-sided Partial Hepatectomy