Mesohepatectomy for hepatocellular carcinoma: a study of 256 patients.
BACKGROUND
Mesohepatectomy is a rarely used operative procedure to treat liver cancer because of its technical complexity. In patients with hepatocellular carcinoma (HCC) with a viral hepatitic/cirrhotic background, this procedure can be used to resect the tumor with adequate margins, while at the same time preserve as much functioning hepatic parenchyma as possible. This retrospective study aimed to evaluate the early results and late survival outcomes of mesohepatectomy in HCC.


METHODS
From 1996 to 2005, 256 patients with HCC situated at the central liver segments (Couinaud segments IV, V, VIII+/-I) were treated with mesohepatectomy. The treatment outcomes of these patients were retrospectively analyzed.


RESULTS
The in-hospital mortality rate was 0.4%, but the postoperative morbidity rate was 28.1%. The 1-, 3-, and 5-year overall survival rates were 77.0, 49.8, and 35.1%, while the 1-, 3-, and 5-year disease-free survival rates were 59.1, 28.8, and 17.0%, respectively. Multivariate analyses showed the significant factors for overall survival were tumor size>8 cm, vascular invasion, and alpha fetoprotein (AFP)>5,000 ng/ml; and for disease-free survival were tumor size>8 cm, vascular invasion, tumor number (three or more), AFP>5,000 ng/ml.


CONCLUSIONS
Mesohepatectomy is a safe and effective treatment for a centrally situated HCC with a viral hepatitic/cirrhotic background.
Chen
Xiao-Ping
XP
Department of Surgery, Hepatic Surgery Center and Institute of HBP Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, People's Republic of China. ChenXP@medmail.com.cn
Qiu
Fa-Zu
FZ
Lau
Wan-Yee
WY
Zhang
Bi-Xiang
BX
Chen
Yi-Fa
YF
Zhang
Wan-Guang
WG
He
Song-Qing
SQ
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
C097353:AFP protein, human; D000509:alpha-Fetoproteins