Long-term results and prognostic factors after anatomical hepatectomy for hepatocellular carcinoma： a report of 90 patients

Objective To investigate the safety and long-term therapeutic results of anatomical hepatectomy for hepatocellular carcinoma （HCC）. Methods 90 patients underwent anatomical hepatectomy from January, 2003 to January, 2010. The tumor size was 45 cm in 38 patients, and ~5 cm in 52 patients. The tumor number was a single lesion in 58 patients, and multiple lesions in 32 patients. Cirrhosis was present in 46 patients （55.42%）, cancer embolus was present in 34 patients （37.78%）. There were 64 patients in Child-Pugh A and 26 patients in B. The operating time, blood loss and blood transfusion were recorded and analyzed. Complications and liver function were moni- tored after surgery. The Kaplan-Meier method was used to calculate the survival rates. Log-rank test was used to analyze factors associating with postoperative recurrence. Independent factors influencing tumor-free survival and overall survival were analyzed by Cox-model logistic regression. Result There was no perioperative death. The incidence of complications was 31.1% （28/90）. The recurrence rate was 51.1% （46/90）. The 1-, 3-, 5-year tumor-free survivals were 92.2%, 67.3% and 49.7%, re- spectively. Positive resection margin and satellite nodule were independent factors for recurrence （RR 19. 22, 95% confidence interval 5.85~63.17）. The 1-, 3-, 5-year overall survivals were 94.4%, 80.0% and 60.0%, respectively. Positive resection margin and TNM were independent factors for overall survival （RR 2. 013, 95% confidence interval 1.28±3.17）. Conclusions Anatomical hepatectomy was a safe and efficacious procedure to treat HCC. Positive resection margin and TNM were independent factors associated with overall survival. Anatomical hepatectomy had the advantages in ensuring a lower rate of negative resection margin. Key words: Hepatocellular carcinoma,Anatomical hepatectomy;  Prognostic factor