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Long-Term Survival Following Hepatectomy for Hepatocellular Carcinoma

The 6 th Chinese Conference on Oncology & 9 th Cross-Strait Academic Conference on Oncology. Long-Term Survival Following Hepatectomy for Hepatocellular Carcinoma. Sheung Tat FAN Department of Surgery, The University of HongKong Chair Professor. Hepatectomy for Hepatocellular Carcinoma.

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Long-Term Survival Following Hepatectomy for Hepatocellular Carcinoma

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  1. The 6th Chinese Conference on Oncology & 9th Cross-Strait Academic Conference on Oncology Long-Term SurvivalFollowing Hepatectomy for Hepatocellular Carcinoma Sheung Tat FAN Department of Surgery, The University of HongKong Chair Professor

  2. Hepatectomy for Hepatocellular Carcinoma

  3. Improvement of prognosis after hepatectomy for hepatocellular carcinoma(1989 – 2008） % major hepatectomy % patients not requiring blood transfusion % hospital death percent

  4. Improvement of prognosis after hepatectomy for hepatocellular carcinoma(1989 – 2008） % major hepatectomy % patients not requiring blood transfusion % hospital death 百分比

  5. 5-year survival: 36% →49%

  6. Refinement of surgical skills • Meticulous perioperative nursing care • Intensive postoperative follow-up

  7. Whether the efficacy of hepatetomy for hepatocellular carcinoma would be further improved?

  8. Comparison of survival rates after hepatectomy for hepatocellular carcinoma *P<0.05

  9. Comparison of survival rates after hepatectomy for hepatocellular carcinomadata of surgery *P<0.05

  10. Comparison of survival rates after hepatectomy for hepatocellular carcinomapathologic data *P<0.05

  11. Comparison of survival rates after hepatectomy for hepatocellular carcinoma *P<0.05

  12. Long-term overall survival rate of patients with hepatocellular carcinoma treated by hepatetomy *P<0.000

  13. Tumor-free survival Overall survival P<0.0001 P=0.0024 1999-2008 (n=772) 1999-2008 (n=808) Cumulative survival（%） Cumulative survival（%） 1989-1998 (n=390) 1989-1998 (n=349) year year

  14. Stage II Stage I 1999-2008 (n=70) P=0.0032 P=0.4523 1999-2008 (n=269) Cumulative survival（%） Cumulative survival（%） 1989-1998 (n=21) 1989-1998 (n=141) year year Stage III Stage IV P=0.0106 P=0.0069 Cumulative survival（%） Cumulative survival（%） 1999-2008 (n=269) 1999-2008 (n=200) 1989-1998 (n=107) 1989-1998 (n=121) year year Comparison of overall survival rates of patients with hepatocellular carcinoma treated by hepatetomy based on TNM Staging(UICC 1997)

  15. Overall survival Overall survival Major hepatectomy Minor hepatectomy P=0.0054 P=0.0002 1999-2008 (n=465) Cumulative survival（%） Cumulative surviva（%） 1999-2008 (n=343) 1989-1998 (n=268) 1989-1998 (n=122) year year Survival rates of patients treated by major hepatectomy VS. minor hepatectomy

  16. Overall survival rates based on potential liver status A cirrhosis P<0.0001 1999-2008 (n=488) Cumulative survival(%） 1989-1998 (n=193) year B Chronic hepatitis P=0.4566 Cumulative survival(%） 1999-2008 (n=219) 1989-1998 (n=143) year C Normal liver P=0.0200 Cumulative survival(%） 1999-2008 (n=101) 1989-1998 (n=54) year

  17. Overall survival P<0.0001 2004-2008 (n=426) Cumulative survival（%） 1999-2003 (n=382) 1994-1998 (n=241) 1989-1993 (n=149) year Continuous improvement of survival rates

  18. Factors affecting survival rates Symptoms Blood loss > 2L Postopertive complications Number of tumor nodules Microvessel invasion Margin of resection TNM staging

  19. Contributions of surgons to the improvement of survival rate Reduce blood loss Avoid postoperative complications Acquire R0 resection

  20. Distribution of 15 min ICG retention rate for patients treated by hepatectomy P < 0.0001 Preoperative 15 min ICG retention rate Median=17.4 Median=11.1 Liver functionChild-Pugh A grade (n=1074) Hospital death4% Liver functionChild-Pugh B grade (n=46) Hospital death8.7% Fan ST, J Hepatobiliary Pancreat Surg, 2009

  21. Liver ischemia Massive bleeding Hyperdynamic injury to small liver remnant Sepsis Liver congestion Liver failure SIRS Mortaluty 範上達, Mastery of Surgery, 2007, P.1090

  22. Invaded right hepatic vein & middle hepatic vein Anterior approach for right hepatectomy, resection of proximal middle hepatic vein &segment IVb hepatic vein Smaller segment II/III

  23. Overall survival rates of liver cancer patients with tumor status meeting Milan Criteria after hepatectomy P=0.0237 72.5% 1999-2008 (n=343) Cumulative survival（%） 1989-1998 (n=110) year

  24. Predicting survival after liver transplantation for patients with liver cancer Mazzaferro V et al, Lancet Oncology, 2009

  25. P=0.0306 70.2% Single tumor 5cm (n=385) Cumulative survival（%） tumor number2-3, each 3cm (n=25) year Comparison of survival after partial hepatectomy single tumor 5cm vs.tumor number2 – 3, each 3cm

  26. Associated factors with the survival of patients meeting Milan Criteria after hepatectomyMultivariate analysis • Major hepatectomy • R0 resection • No postoperative complications • No microvessel invasions

  27. living donor liver transplantation(n=36) Partial hepatectomy (n=116) Cumulative survival（%） P=0.2684 Comparison of survival between patients treated by major hepatectomy (single tumor 5cm, negtive margin) and patients receiving living donor liver transplantation

  28. Patients survive more than 10 years (n=127) 26.4% Cumulative survival（%） P<0.0001 Patients survive less than 10 years(n=354) year Long-term survival after partial hepatectomy （1989 – 2000.5）

  29. Tumor-free survive more than 10 years(n=74) 17% Cumulative survival（%） P<0.0001 Tumor-free survive less than 10 years(n=360) year Cumulative survival rate of tumor-free patients vs. Patients with recurrence in 10 years after hepatectomy for cancer (1989 – May 2000)

  30. Death reasons for patients survived more than 10 years without recurrence

  31. Summary 5 -year TNM StagingI 81.7% II 77.2% IIIA 44% IVA 28.2% For the patients with high TNM staging, the efficacy of patients comlicated with cirrhosis receiving major hepatectomy improves continuously. The efficacy of hepatectomy with tumor status meeting Milan Criteria is similar to liver transplantation. For patients with resectable liver cancer, hapetectomy still remains the first choice in areas short of corpse organs.

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