GENERAL SURGERY

 

Liver resection for non-cirrhotic hepatocellular carcinoma in South African patients

 

 

F. Bhaijee^I; J. E. J. Krige^II; M. L. Locketz^III; M. C. Kew^IV

^IM.B. Ch.B.; Surgical Gastroenterology Unit, Groote Schuur Hospital, and Faculty of Health Sciences, University of Cape Town, and Department of Pathology, University of Mississippi Medical Centre, Jackson, Mississippi, USA
^IIM.B. Ch.B., F.A.C.S., F.R.C.S. (ed.), F.C.S. (A.A.); Surgical Gastroenterology Unit, Groote Schuur Hospital, and Department of Surgery, Faculty of Health Sciences, University of Cape Town
^IIIM.B. Ch.B., F.C.Path. (S.A.) Anat.; Department of Pathology, Faculty of Health Sciences, University of Cape Town
^IVM.B. Ch.B., Ph.D., M.D., D.Sc., F.C.P. (S.A.)., F.R.C.P.(lond.); Department of Medicine, Faculty of Health Sciences, University of Cape Town

 

 

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ABSTRACT

BACKGROUND: We describe the clinicopathologic features and outcome of South African patients who have undergone hepatic resection for hepatocellular carcinoma (HCC) arising in a non-cirrhotic liver.
METHODS: We utilised the prospective liver resection database in the Surgical Gastroenterology Unit at Groote Schuur Hospital, Cape Town, to identify all patients who underwent surgery for HCC with non-cirrhotic liver parenchyma between 1990 and 2008.
RESULTS: Twenty-two patients (10 men, 12 women, 3 black, 19 white, median age 47 years, range 21 - 79 years) underwent surgery for non-cirrhotic HCC. Sixteen patients had non-fibrolamellar HCC (Group 1); 6 patients had fibrolamellar HCC (Group 2). Group 1 had a median age of 55 years, and 6 (38%) were men; group 2 had a median age of 21 years, and 5 (83%) were men. Most patients had a solitary tumour at diagnosis; median largest tumour diameters in Groups 1 and 2 were 10 cm (range 4 - 21) and 12 cm (range 4 - 17), respectively. Patients in Group 1 underwent extended right hepatectomy (N=3), right hepatectomy (N=3), left hepatectomy (N=3), partial hepatectomy (N=7), cholecystectomy (N=6), and appendicectomy (N=1). Patients in Group 2 underwent extended right hepatectomy (N=1), right hepatectomy (N=1), left hepatectomy (N=2), segmentectomy (N=2), and portal lymphadenectomy (N=3). Recurrence rates in Groups 1, 2, and overall were 81%, 100% and 86%, respectively. Median overall survival was 46 months, with 1-, 3-, and 5-year survival rates of 95%, 59% and 45%, respectively. In Group 1, median survival was 39 months, with 1-, 3-, and 5-year survival rates of 100%, 56% and 38% respectively. In Group 2, median survival was 61 months, with 1-, 3-, and 5-year survival rates of 83%, 67% and 67%, respectively.
CONCLUSION: Despite aggressive surgical resection, HCC arising in normal liver parenchyma has a high recurrence rate and an ultimately poor outcome. This finding is similar to both the recent international experience of non-cirrhotic HCC and local experience of fibrolamellar HCC.

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REFERENCES

1. Bosch FX, Ribes J, Diaz M. Primary liver cancer: worldwide incidence and trends. Gastroenterology 2004;127:S5-S16.         [ Links ]

2. Thomas MB, Jaffe D, Choti MM, et al. Hepatocellular carcinoma: consensus recommendations of the National Cancer Institute Clinical Trials Planning Meeting. J Clin Oncol 2010;28:3994-4005.         [ Links ]

3. Ferenci P, Fried M, Labrecque D, et al. World Gastroenterology Organisation Guidelines. Hepatocellular carcinoma: a global perspective. J Gastrointestin Liver Dis 2010;19:311-317.         [ Links ]

4. Kew MC. Hepatocellular carcinoma in Africa. In: Malignant Liver Tumors: Current and Emerging Therapies, 2nd ed. Clavien PA, ed. Boston: Jones and Bartlett; 2003:439-448.         [ Links ]

5. Kew MC. Hepatocellular carcinoma in African Blacks: Recent progress in etiology and pathogenesis. World J Hepatol 2010;27(2):65-73.         [ Links ]

6. Kew MC. Prevention of hepatocellular carcinoma. HPB 2005;7:16-25.         [ Links ]

7. Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, eds. Harrison's Principles of Internal Medicine, 15th ed. Vol 1. New York: McGraw-Hill, 2001.         [ Links ]

8. Lang H, Sotiropoulos GC, Brokalaki EI, et al. Survival and recurrence rates after resection for hepatocellular carcinoma in noncirrhotic livers. J Am Coll Surg 2007;205:27-36.         [ Links ]

9. Kew MC, Marcus R, Geddes EW. Some characteristics of Mozambican Shangaans with primary hepatocellular cancer. S Afr Med J 1977;51:306-309.         [ Links ]

10. Lubrano J, Huet E, Tsilividis B, et al. Long-term outcome of liver resection for hepatocellular carcinoma in noncirrhotic nonfibrotic liver with no viral hepatitis or alcohol abuse. World J Surg 2008;32:104-109.         [ Links ]

11. Dupont-Bierre E, Compagnon P, Raoul J-L, et al. Resection of hepatocellular carcinoma in noncirrhotic liver: Analysis of risk factors for survival. J Am Coll Surg 2005;201:663-670.         [ Links ]

12. Lang H, Sotiropoulos GC, Domland M, et al. Liver resection for hepatocellular carcinoma in non-cirrhotic liver without underlying viral hepatitis. Br J Surg 2005;92:198-202.         [ Links ]

13. Grazie GL, Cescon M, Ravaioli M, et al. Liver resection for hepatocellular carcinoma in cirrhotics and noncirrhotics. Evaluation of clinicopathologic features and comparison of risk factors for long-term survival and tumour recurrence in a single centre. Aliment Pharmacol Ther 2003;17(Suppl 2):119-129.         [ Links ]

14. Laurent C, Blanc JF, Nobili S, et al. Prognostic factors and longterm survival after hepatic resection for hepatocellular carcinoma originating from noncirrhotic liver. J Am Coll Surg 2005;201:656-662.         [ Links ]

15. Nagasue N, Ono T, Yamanoi A, et al. Prognostic factors and survival after hepatic resection for hepatocellular carcinoma without cirrhosis. Br J Surg 2001;88:515-522.         [ Links ]

16. Shimada M, Rikimaru T, Sugimachi K, et al. The importance of hepatic resection for hepatocellular carcinoma originating from nonfibrotic liver. J Am Coll Surg 2000;191:531-537.         [ Links ]

17. Yokoi Y, Suzuki S, Baba S, Inaba K, Konno H, Nakamura S. Clinicopathological features of hepatocellular carcinomas arising in patients without chronic viral infection or alcohol abuse: a retrospective study of patients undergoing hepatic resection. J Gastroenterol 2005;40:274-282.         [ Links ]

18. Kew MC. Hepatocellularcarcinoma with and without cirrhosis. A comparison in southern African blacks. Gastroenterology 1989;97:136-139.         [ Links ]

19. Kew MC, Geddes EW, Macnab GM, Bersohn I. Hepatitis-B antigen and cirrhosis in Bantu patients with primary liver cancer. Cancer 1974;34:538-541.         [ Links ]

20. Terblanche J, Krige JE, Bornman PC. Simplified hepatic resection with the use of prolonged vascular inflow occlusion. Arch Surg 1991;126:298-301.         [ Links ]

21. Bhaijee F, Locketz ML, Krige JE. Fibrolamellar hepatocellular carcinoma at a tertiary centre in South Africa: a case series. S Afr J Surg 2009;47:108-111.         [ Links ]

22. Couinaud C. Anatomical principles of left and right regulated hepatectomy: technics. J Chir (Paris) 1954;70:933-966.         [ Links ]

23. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications. Ann Surg 2004;240:205-213.         [ Links ]

24. Brancatelli G, Federle MP, Grazioli L, Carr BI. Hepatocellular carcinoma in noncirrhotic liver: CT, clinical, and pathological findings in 39 US residents. Radiology 2002;222:89-94.         [ Links ]

25. Smalley SR, Moertel CG, Hilton JF, et al. Hepatoma in the noncirrhotic liver. Cancer 1988;62:1414-1424.         [ Links ]

26. Benzoni E, Molaro R, Cedolini C, et al. Liver resection for HCC: analysis of causes and risk factors linked to postoperative complications. Hepatogastroenterology 2007;54:186-189.         [ Links ]

27. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology 2005;42:1208-1236.         [ Links ]

28. Jarnagin W, Chapman WC, Curley S. Surgical treatment of hepatocellular carcinoma. HPB 2010;12:302-310.         [ Links ]

29. Poon RT, Fan ST, Ng IO, Wong J. Significance of resection margin in hepatectomy for hepatocellular carcinoma: A critical reappraisal. Ann Surg 2000;231:544-551.         [ Links ]

30. Nakashima Y, Nakashima O, Tanaka M, Okuda K, Nakashima M, Kojiro M. Portal vein invasion and intrahepatic micrometastasis in small hepatocellular carcinoma by gross type. Hepatol Res 2003;26:142-147.         [ Links ]

31. Borie F, Bouvier A-M, Herrero A, et al. Treatment and prognosis of hepatocellular carcinoma: A population based study in France. J Surg Oncol 2008;98:505-509.         [ Links ]

32. Bruix J, Llovet JM. Major achievements in hepatocellular carcinoma. Lancet 2009;21(373):614-616.         [ Links ]

33. Tsim NC, Frampton AE, Habib NA, Jiao LR. Surgical treatment for liver cancer. World J Gastroenterol 2010;16:927-933.         [ Links ]

34. Fong Y, Sun RL, Jarnagin W, Blumgart LH. An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg 1999;229:790-999, discussion 799-800.         [ Links ]

35. Chang C-H, Chau G-Y Long-term results of hepatic resection for hepatocellular carcinoma. Arch Surg 2004;139:320-325.         [ Links ]