title: Hepatectomy for hepatocellular carcinoma: the surgeon's role in long-term survival.
abstract: OBJECTIVE
  The surgeon can contribute substantially to the long-term survival rate of patients undergoing hepatectomy for hepatocellular carcinoma (HCC).
  
  
  METHODS
  The long-term survival rate of patients with HCC undergoing hepatectomy has improved, but the contribution of the surgeon to the improved survival rate is unknown. We surveyed 211 consecutive patients undergoing hepatectomy for HCC. The clinical, operative, and pathological factors were analyzed to identify factors that were important in affecting long-term survival.
  
  
  METHODS
  A tertiary referral center.
  
  
  METHODS
  From April 1989 to December 1995, 211 consecutive patients with HCC underwent 153 major and 58 minor hepatectomies.
  
  
  METHODS
  Disease-free and overall cumulative survival rate.
  
  
  RESULTS
  The 5-year disease-free survival rate was 27%. By Cox regression analysis, blood transfusion (relative risk [RR], 1.21; 95% confidence interval [CI], 1.05-1.40) and TNM stage (RR, 1.90; 95% CI, 1.47-2.47) were shown to be independent prognostic factors in the 5-year disease-free survival rate. The 5-year overall cumulative survival rate was 37%. By Cox regression analysis, the preoperative indocyanine green retention value at 15 minutes after injection (RR, 1.03; 95% CI, 1.01-1.06), blood transfusion (RR, 1.191; 95% CI, 1.078-1.316), tumor rupture (RR, 1.48; 95% CI, 1.08-2.04), and TNM stage (RR, 1.62; 95% CI, 1.27-2.07) were shown to be significant independent factors that influenced cumulative survival rate.
  
  
  CONCLUSIONS
  The long-term survival of patients with HCC after hepatectomy depends on tumor staging, preoperative hepatic functional reserve, history of blood transfusion, and rupture of HCC. Preoperative liver function and tumor staging cannot be altered; however, the surgeon can play an important role in improving the prognosis if blood transfusion and iatrogenic tumor rupture can be avoided and if function of the liver remnant can be preserved.
authors.affiliation: Department of Surgery, the University of Hong Kong, Queen Mary Hospital, China. hrmsfst@hkucc.hku.hk
authors.forename: S T
authors.initials: ST
authors.lastname: Fan
authors.forename: I O
authors.initials: IO
authors.lastname: Ng
authors.forename: R T
authors.initials: RT
authors.lastname: Poon
authors.forename: C M
authors.initials: CM
authors.lastname: Lo
authors.forename: C L
authors.initials: CL
authors.lastname: Liu
authors.forename: J
authors.initials: J
authors.lastname: Wong
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors