title: Factors predictive of survival after stapler hepatectomy of hepatocellular carcinoma: a multivariate, single-center analysis.
abstract: BACKGROUND
  New technical devices for hepatic parenchymal transection have improved perioperative safety and patient survival. The aim of the present study was to determine the oncological outcome after stapler hepatectomy in patients with HCC.
  
  
  METHODS
  Data of 95 patients who underwent stapler hepatectomy for HCC between 2001 and 2011 were analyzed retrospectively regarding clinical safety of the procedure and predictive factors for survial.
  
  
  RESULTS
  Thirty-nine minor (≤2 segments) and 56 major (≥3 segments) hepatic resections were performed. The median survival was 47.5 months, after 36 months follow-up. Low grading, tumors ≥5 cm, multiple nodules and liver cirrhosis were predictors of decreased overall survival using multivariate analysis with hazard ratio(HR)=2.62, 2.41, 2.05, and 1.92 respectively. An estimated intra-operative blood loss of ≥1.2l was inversely correlated to disease free survival (HR=1.96).
  
  
  CONCLUSIONS
  Stapler hepatectomy is a safe procedure in patients with HCC. Substantial intraoperative blood loss and the presence of cirrhosis independently predict the overall probability of patient survival. Intraoperative blood loss directly impacts HCC recurrence.
authors: Department of General and Transplant Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. peter.schemmer@med.uni-heidelberg.de.
authors: Katrin
authors: K
authors: Hoffmann
authors: Verena
authors: V
authors: Müller-Bütow
authors: Clemens
authors: C
authors: Franz
authors: Ulf
authors: U
authors: Hinz
authors: Thomas
authors: T
authors: Longerich
authors: Markus W
authors: MW
authors: Büchler
authors: Peter
authors: P
authors: Schemmer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Hepatocellular carcinoma; liver resection; stapler hepatectomy; survival