title: A survival benefit of major hepatectomy for hepatocellular carcinoma identified by preoperative [18F] fluorodeoxyglucose positron emission tomography in patients with well-preserved hepatic function.
abstract: OBJECTIVE
  Hepatic resection can cure hepatocellular carcinoma (HCC). However, the optimal extent of resection remains controversial. Major hepatectomy could minimize a tumor recurrence, but it is harmful due to decreased hepatic functional reserve. [18F] fluorodeoxyglucose positron emission tomography (FDG-PET) scans are known as their reflection tumor differentiation and biological activity in HCC. To evaluate a benefit of major hepatectomy for HCC, we performed this retrospective analysis in patients with well-preserved hepatic function, and further analyzed in the subset identified by preoperative FDG-PET.
  
  
  METHODS
  We reviewed the medical records of 189 patients with HCC who underwent curative resection between August 2004 and December 2010 at two institutes. All patients underwent anatomical resection, either by major or minor hepatectomy.
  
  
  RESULTS
  Median overall survival did not differ significantly between the major and minor hepatectomy groups (29.4 versus 26.3 months, p = 0.269). However, the major hepatectomy group had a better recurrence-free survival (24.5 versus 19.9 months, p = 0.004). On multivariate analysis, the presence of intrahepatic metastasis independently predicted overall survival (p = 0.009), but other examined variables did not. Overall survival and recurrence-free survival were significantly better following major hepatectomy rather than minor hepatectomy in patients whose preoperative FDG-PET indicated that the maximum standardized uptake value of the tumor (SUVtumor) was ≥4 and the tumor-to-nontumor SUV ratio (TNR) was ≥1.5.
  
  
  CONCLUSIONS
  Our findings suggest that preoperative FDG-PET may be useful in identifying patients with favorable hepatic reserve who are most likely to benefit from major rather than minor hepatectomy.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, 250, Seongsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: S G
authors.initials: SG
authors.lastname: Ahn
authors.forename: T J
authors.initials: TJ
authors.lastname: Jeon
authors.forename: S D
authors.initials: SD
authors.lastname: Lee
authors.forename: S H
authors.initials: SH
authors.lastname: Kim
authors.forename: H J
authors.initials: HJ
authors.lastname: Cho
authors.forename: M
authors.initials: M
authors.lastname: Yun
authors.forename: Y N
authors.initials: YN
authors.lastname: Park
authors.forename: J D
authors.initials: JD
authors.lastname: Lee
authors.forename: S J
authors.initials: SJ
authors.lastname: Park
authors.forename: K S
authors.initials: KS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000502:physiology* / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: FDG-PET; Hepatocellular carcinoma; Major hepatectomy; Prognostic factor