title: Additional hepatocellular carcinomas undetectable before surgery.
abstract: The presence of small additional hepatocellular carcinomas (HCCs) undetectable before hepatic resection is a crucial topic for hepatic surgeons. We assessed the incidence of pathologically diagnosed multiple HCCs in 267 patients who underwent hepatic resection for HCC. Ninety-five additional HCC nodules were detected in 72 of the patients (27%). The survival rate of these 72 patients was significant worse than for the 195 with single nodular HCC (p = 0.0013). Twenty-one (22%) were detected before surgery, 29 (31%) during surgery, and 45 (47%) on pathologic examination after surgery. The mean nodule diameters for each group were 2.1, 1.0, and 0.9 cm, respectively (p < 0.0001). None of the 21 nodules detected before surgery was well differentiated, whereas 30 of the 74 nodules in the other two groups were well-differentiated. Although the mean nodule diameter of the well-differentiated HCC group was the smallest, there was no significant difference among the three groups assigned according to tumor differentiation (p = 0.2355). Altogether, 9 of 16 patients with additional nodules detected before surgery (56%) and 49 of 59 with additional nodules detected during or after surgery (88%) had cirrhosis of the liver. The odds ratio for detecting a new HCC nodule during or after surgery in the presence of cirrhosis was 5.444 (p = 0.0087). Improvement in the detection of small additional HCC nodules before and during surgery and meticulous follow-up after surgery are necessary for patients with cirrhosis. For patients without cirrhosis, surgical treatment may be performed according to the results of preoperative imaging studies.
authors.affiliation: Second Department of Surgery, Osaka City University Medical School, Japan. shutou@med.osaka-cu.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Shuto
authors.forename: K
authors.initials: K
authors.lastname: Hirohashi
authors.forename: T
authors.initials: T
authors.lastname: Ikebe
authors.forename: S
authors.initials: S
authors.lastname: Mikami
authors.forename: T
authors.initials: T
authors.lastname: Yamamoto
authors.forename: S
authors.initials: S
authors.lastname: Kubo
authors.forename: K
authors.initials: K
authors.lastname: Wakasa
authors.forename: H
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000473:pathology* / Q000601:surgery; D016016:Proportional Hazards Models; D015996:Survival Rate; D016896:Treatment Outcome