Faculty Collaboration Database

Large hepatocellular carcinoma: time to stop preoperative biopsy. J Am Coll Surg 2007 Sep;205(3):453-62

Date

09/04/2007

Pubmed ID

17765162

DOI

10.1016/j.jamcollsurg.2007.04.033

Scopus ID

2-s2.0-34548151233 (requires institutional sign-in at Scopus site)   38 Citations

Abstract

BACKGROUND: In Western countries, hepatocellular carcinoma (HCC) often presents at a large size, which is seen as a contraindication to transplantation and often resection. Although diagnosis by imaging and alpha-fetoprotein is usually straightforward, nonspecialist units continue to use biopsy to prove the diagnosis before transfer for specialist surgical opinion. We have looked at the impact of this on our practice.

STUDY DESIGN: We retrospectively analyzed all large HCCs resected in our unit during the last 12 years. Survival data were calculated according to size and univariate and multivariate analyses were carried out to determine impact of preoperative, operative, and histologic factors affecting outcomes.

RESULTS: We identified 85 large HCCs (> 3 cm) and classified 42 as giant (> 10 cm). Overall survival at 1, 3, and 5 years was 76%, 54%, and 51%. Size did not influence survival, although more complex surgical techniques were required for giant tumors. Predictors of poorer disease-free survival were positive resection margin (p < 0.001), multiple tumors (p = 0.003), macroscopic vascular invasion (p = 0.015), and preoperative lesion biopsy (p = 0.027).

CONCLUSIONS: Our data shows excellent outcomes after resection for large HCC. This supports the management of such patients in large-volume units that are fully equipped and experienced in the management of these patients. Preoperative biopsy should be avoided, as this unnecessary maneuver appears to have worsened our longterm results.

Author List

Young AL, Malik HZ, Abu-Hilal M, Guthrie JA, Wyatt J, Prasad KR, Toogood GJ, Lodge JP

Author

Kondragunta Rajendra Prasad MBBS Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Biopsy
Carcinoma, Hepatocellular
Female
Humans
Liver Neoplasms
Male
Middle Aged
Preoperative Care
Proportional Hazards Models
Retrospective Studies
Statistics, Nonparametric
Survival Rate
Unnecessary Procedures