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Single large hepatocellular carcinoma > 5 cm with surgical indication: is it mandatory a major hepatectomy? a propensity-score weighted analysis

  • 期刊论文

  • 发表日期：

    2024年8月11日

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  • Mattia Garancini,
  • Matteo Serenari,
  • Simone Famularo,
  • Federica Cipriani,
  • Francesco Ardito,
  • Nadia Russolillo,
  • Simone Conci,
  • Daniele Nicolini,
  • Pasquale Perri,
  • Matteo Zanello,
  • Maurizio Iaria,
  • Quirino Lai,
  • Maurizio Romano,
  • Giuliano La Barba,
  • Sarah Molfino,
  • Paola Germani,
  • Tommaso Dominioni,
  • Giuseppe Zimmiti,
  • Maria Conticchio,
  • Luca Fumagalli,
  • Mauro Zago,
  • Albert Troci,
  • Ivano Sciannamea,
  • Cecilia Ferrari,
  • Mauro Alessandro Scotti,
  • Guido Griseri,
  • Adelmo Antonucci,
  • Michele Crespi,
  • Enrico Pinotti,
  • Marco Chiarelli,
  • Riccardo Memeo,
  • Mohamed Abu Hilal,
  • Marcello Maestri,
  • Paola Tarchi,
  • Gianluca Baiocchi,
  • Giorgio Ercolani,
  • Giacomo Zanus,
  • Massimo Rossi,
  • Raffaele Dalla Valle,
  • Elio Jovine,
  • Antonio Frena,
  • Stefan Patauner,
  • Gian Luca Grazi,
  • Marco Vivarelli,
  • Andrea Ruzzenente,
  • Alessandro Ferrero,
  • Felice Giuliante,
  • Luca Aldrighetti,
  • Guido Torzilli,
  • Matteo Cescon,
  • Davide Bernasconi,
  • Fabrizio Romano,
  • Flavio Milana,
  • Alessandra Bertacco,
  • Francesca Ratti,
  • Francesco Razionale,
  • Ottavia Cicerone,
  • Federico Fazio,
  • Cristina Ciulli,
  • Francesca Carissimi,
  • Zoe Larghi Laureiro,
  • Laura Marinelli,
  • Valerio De Peppo,
  • Mauro Montuori,
  • Ivan Marchitelli,
  • Angelo Franceschi,
  • Alberto Manzoni,
  • Davide Cosola,
  • Pio Corleone,
  • Luca Salvador,
  • Alessandro Cucchetti,
  • Luca Pennacchi,
  • Mario Giuffrida,
  • Paola Fugazzola,
  • Annachiara Casella,
  • Pietro Calcagno

摘要

Purpose

Single large hepatocellular carcinoma >5cm (SLHCC) traditionally requires a major liver resection. Minor resections are often performed with the goal to reduce morbidity and mortality. Aim of the study was to establish if a major resection should be considered the best treatment for SLHCC or a more limited resection should be preferred.

Methods

A multicenter retrospective analysis of the HE.RC.O.LE.S. Group register was performed. All collected patients with surgically treated SLHCC were divided in 5 groups of treatment (major hepatectomy, sectorectomy, left lateral sectionectomy, segmentectomy, non-anatomical resection) and compared for baseline characteristics, short and long-term results. A propensity-score weighted analysis was performed.

Results

535 patients were enrolled in the study. Major resection was associated with significantly increased major complications compared to left lateral sectionanectomy, segmentectomy and non-anatomical resection (all p<0.05) and borderline significant increased major complications compared to sectorectomy (p=0.08). Left lateral sectionectomy showed better overall survival compared to major resection (p=0.02), while other groups of treatment resulted similar to major hepatectomy group for the same item. Absence of oncological benefit after major resection and similar outcomes among the 5 groups of treatment was confirmed even in the sub-population excluding patients with macrovascular invasion.

Conclusion

Major resection was associated to increased major post-operative morbidity without long-term survival benefit; when technically feasible and oncologically adequate, minor resections should be preferred for the surgical treatment of SLHCC.