Analysis of Patient Outcome after Non-curative Resection for Hepatocellular Carcinoma Using Nationwide Survey Data in Ja
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ORIGINAL SCIENTIFIC REPORT
Analysis of Patient Outcome after Non-curative Resection for Hepatocellular Carcinoma Using Nationwide Survey Data in Japan Taku Aoki1 • Keiichi Kubota1 • Shoji Kubo2 • Susumu Eguchi3 • Namiki Izumi4 • Norihiro Kokudo5 • Michiie Sakamoto6 • Shuichiro Shiina7 • Tadatoshi Takayama8 • Osamu Nakashima9 • Yutaka Matsuyama10 • Takamichi Murakami11 • Masatoshi Kudo12
Accepted: 11 October 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Non-curative (debulking) hepatic resection for hepatocellular carcinoma (HCC) is occasionally applied for selected cases with bulky tumors or for oncologic emergency cases; however, the clinical usefulness of this procedure has not yet been fully evaluated. The aim of the present study was to evaluate the patient outcomes of noncurative hepatic resections for HCC using data from bi-annual nationwide surveys conducted in Japan. Method Data of 1084 non-curative hepatic resections for HCC were collected. The patient outcomes were compared with those of curative resections, transcatheter arterial chemoembolization (TACE), and hepatic arterial infusion chemotherapy (HAIC). Results Patient survival after the non-curative resection was poorer than that after curative resection (P \ 0.001) and was especially dismal in cases with extrahepatic tumor spread (lymph node metastasis, peritoneal seeding, or distant metastasis). As compared to cases receiving TACE without surgery, non-curative resections for multiple intrahepatic tumors were applied to cases with advanced tumors with good liver functional reserve. The survival outcomes were significantly more favorable in the TACE group, but the results became similar after propensity score matching of the patients. The survival outcome of patients receiving non-curative resections was better than that of cases treated by HAIC, with median survival times of 26.0 months and 10.0 months, respectively. Conclusion The indications for non-curative hepatic resection in patients with HCC should be judged cautiously, especially in patients with extrahepatic tumor spread. This treatment approach may be beneficial for selected patients with intermediate- or advanced-stage HCC limited in liver and with good liver functional reserve.
& Taku Aoki [email protected]
5
National Center for Global Health and Medicine, Tokyo, Japan
6 1
Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochi 321-0293, Japan
Department of Pathology, Keio University School of Medicine, Tokyo, Japan
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2
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
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3
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
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4
Department of Gastroenterology, Musashino Red Cross Hospital, Tokyo, Japan
Department of Clinical Laborator
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