title: Resection of a transplantable single-nodule hepatocellular carcinoma in Child-Pugh class A cirrhosis: factors affecting survival and recurrence.
abstract: BACKGROUND
  The aim of this study was to estimate the survival rates and define risk factors for tumor recurrence after resection surgery for single hepatocellular carcinomas (HCCs)≤5 cm (on preoperative imaging) that developed on compensated cirrhosis.
  
  
  METHODS
  A retrospective review studied patients treated by surgical resection. Overall survival (OS), disease-free survival (DFS), recurrence rates, and risk factors were studied for all patients.
  
  
  RESULTS
  A total of 49 patients were treated by resection. The 5-year OS and DFS rates were 52 and 41%, respectively, after 2000. Three independent risk factors were found for OS and DFS: macroscopic vascular invasion, satellite nodules, R1 resection. In the absence of these three factors, the 5-year OS was 59%. Recurrence rates were 63%. Delayed recurrence was significantly related to the 5-year OS. One factor was correlated with early recurrence: the presence of satellite nodules; and one factor was correlated with late recurrence: hepatitis C virus infection.
  
  
  CONCLUSIONS
  R0 resection for HCC on compensated cirrhosis may offer good long-term survival in the absence of satellites nodules and macrovascular invasion. Thus, a "first approach" resection is proposed with the possibility of "salvage transplantation." In other cases, resection may be a bridge to transplantation ("transplantation de principe").
authors.affiliation: Liver Transplantation and Digestive Surgery Unit, University Hospital of Rangueil, Toulouse, France. muscari.f@chu-toulouse.fr
authors.forename: Fabrice
authors.initials: F
authors.lastname: Muscari
authors.forename: Bertrand
authors.initials: B
authors.lastname: Foppa
authors.forename: Nicolas
authors.initials: N
authors.lastname: Carrere
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Peron
authors.forename: Bertrand
authors.initials: B
authors.lastname: Suc
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies