Changing trends in long-term outcomes after hepatic resection for hepatocellular carcinoma: A 30-year, single-center experience.
BACKGROUND
The aim of this study was to characterize changes in outcome following hepatectomy for hepatocellular carcinoma (HCC) over a 30-year period.


METHODS
The clinical records of 372 patients who underwent a macroscopic curative hepatectomy for treatment of HCC between 1980 and 2009 were retrospectively examined. Patients were divided into two groups: an early group (1980-2000) and a late group (2001-2009). The relationship between the chronological treatment period and the surgical outcomes was investigated.


RESULTS
The disease-free survival (DFS) was comparable between the early and late groups (at 5 years: 30.3% vs. 31.2%, p=0.526), however, the overall survival (OS) of the late group was significantly better than the one of the early group (at 5 years: 80.1% vs. 50.4%, p<0.001), with this being an independent prognostic factor. Among the 148 patients who underwent transarterial chemoembolization (TACE) for initial hepatic recurrence, the OS after initial recurrence of the late group was significantly better than that of the early group (p=0.002). The OS after initial recurrence was significantly better in patients who underwent repeat hepatectomy than in those who underwent TACE (p=0.044).


CONCLUSIONS
The results of hepatectomy for HCC have improved over time by use of various combination therapies after initial HCC recurrence. A repeat hepatectomy may be an acceptable treatment option for HCC recurrence in selected patients.
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku Kyoto 6028566, Japan. ikoma@koto.kpu-m.ac.jp.
Yusuke
Y
Yamamoto
Hisashi
H
Ikoma
Ryo
R
Morimura
Hirotaka
H
Konishi
Yasutoshi
Y
Murayama
Shuhei
S
Komatsu
Atsushi
A
Shiozaki
Yoshiaki
Y
Kuriu
Takeshi
T
Kubota
Masayoshi
M
Nakanishi
Daisuke
D
Ichikawa
Hitoshi
H
Fujiwara
Kazuma
K
Okamoto
Chouhei
C
Sakakura
Toshiya
T
Ochiai
Eigo
E
Otsuji
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
Hepatocellular carcinoma; hepatectomy; long-term survival; repeat hepatectomy; transarterial chemoembolization