Risk factors of post‐operative recurrence and adequate surgical approach to improve long‐term outcomes of hepatocellular carcinoma

AbstractIntroductionA high recurrence rate of hepatocellular carcinoma (HCC) remains a significant concern. The risk factors for recurrence were analysed and the optimal surgical approaches were investigated.MethodsThe subjects comprised 280 consecutive patients with primary solitary HCC measuring ≤5 cm in diameter, who underwent curative resections. Multivariate analysis was conducted to identify the risk factors for post‐operative recurrence, and the clinical significance of an anatomic resection was evaluated.ResultsMultivariate analysis identified HCV infection, a des‐gamma‐carboxyprothrombin level >100 mAU/ml, underlying cirrhosis, the presence of microvascular invasion, the presence of micrometastases and non‐anatomic resection as being significant risk factors for post‐operative recurrence. The 5‐year recurrence rate was 56.7% in the anatomic resection (AR) group and 74.7% in the non‐AR group. The 5‐year survival rate was 82.2% in the AR group and 71.9% in the non‐AR group. Local recurrence within the same segment was observed in 25% of the patients of the non‐AR group. The prognostic superiority of AR was confirmed only in patients with histopathological evidence of microvascular invasion and/or micrometastases, and in patients having a solitary HCC measuring 2 to 5 cm in diameter.ConclusionsAnatomic resection may decrease local recurrence and improve the surgical outcomes in solitary HCC measuring 2 to 5 cm in diameter