Surgical Resection for Hepatocellular Carcinoma with Concomitant Esophageal Varices

Noboru Harada, Ken Shirabe, Takashi Maeda, Hiroto Kayashima, Teruyoshi Ishida, Yoshihiko Maehara

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: The management of hepatocellular carcinoma (HCC) in patients with concomitant esophageal varices (EV) remains controversial. We assessed the surgical outcome of hepatectomy and aimed to clarify the indications and management of HCC in patients with concomitant EV. Methods: We retrospectively enrolled 502 patients with HCC (100 with and 402 without EV), who underwent curative hepatectomy. We analyzed the prognostic outcomes and risk factors for EV bleeding after hepatectomy. Results: Overall survival (OS) was significantly lower in HCC patients with EV than in those without EV (p = 0.003), although recurrence-free survival was similar in both groups. Multivariate analysis showed that indocyanine green retention test at 15 min (ICGR15) >17 % (p = 0.007) and α-fetoprotein >12.5 ng/ml (p = 0.003) was independent predictors of poorer OS. Among patients with EV who underwent hepatectomy, multivariate analysis identified ICGR15 >17 % (p = 0.03) as the only independent predictor of poorer OS. There was no significant difference in OS between HCC patients with EV and ICGR15 ≤17.0 % and HCC patients without EV. Ten patients experienced EV bleeding after hepatectomy. Multivariate analysis showed that preoperative endoscopic findings of blue color EV (p = 0.008) and red color sign (p = 0.0005) were independent predictors of EV bleeding in patients with HCC after hepatectomy. Conclusions: These results suggest that HCC patients with EV and ICGR15 ≤17 % may be suitable for surgery, but patients with preoperative endoscopic blue color EV and red color sign need to be managed appropriately.

Original languageEnglish
Pages (from-to)2510-2518
Number of pages9
JournalWorld journal of surgery
Volume39
Issue number10
DOIs
Publication statusPublished - Oct 1 2015

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Esophageal and Gastric Varices
Hepatocellular Carcinoma
Hepatectomy
Indocyanine Green
Color
Survival
Multivariate Analysis
Hemorrhage
Fetal Proteins

All Science Journal Classification (ASJC) codes

  • Surgery

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Surgical Resection for Hepatocellular Carcinoma with Concomitant Esophageal Varices. / Harada, Noboru; Shirabe, Ken; Maeda, Takashi; Kayashima, Hiroto; Ishida, Teruyoshi; Maehara, Yoshihiko.

In: World journal of surgery, Vol. 39, No. 10, 01.10.2015, p. 2510-2518.

Research output: Contribution to journalArticle

Harada, N, Shirabe, K, Maeda, T, Kayashima, H, Ishida, T & Maehara, Y 2015, 'Surgical Resection for Hepatocellular Carcinoma with Concomitant Esophageal Varices', World journal of surgery, vol. 39, no. 10, pp. 2510-2518. https://doi.org/10.1007/s00268-015-3110-9
Harada, Noboru ; Shirabe, Ken ; Maeda, Takashi ; Kayashima, Hiroto ; Ishida, Teruyoshi ; Maehara, Yoshihiko. / Surgical Resection for Hepatocellular Carcinoma with Concomitant Esophageal Varices. In: World journal of surgery. 2015 ; Vol. 39, No. 10. pp. 2510-2518.
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N2 - Background: The management of hepatocellular carcinoma (HCC) in patients with concomitant esophageal varices (EV) remains controversial. We assessed the surgical outcome of hepatectomy and aimed to clarify the indications and management of HCC in patients with concomitant EV. Methods: We retrospectively enrolled 502 patients with HCC (100 with and 402 without EV), who underwent curative hepatectomy. We analyzed the prognostic outcomes and risk factors for EV bleeding after hepatectomy. Results: Overall survival (OS) was significantly lower in HCC patients with EV than in those without EV (p = 0.003), although recurrence-free survival was similar in both groups. Multivariate analysis showed that indocyanine green retention test at 15 min (ICGR15) >17 % (p = 0.007) and α-fetoprotein >12.5 ng/ml (p = 0.003) was independent predictors of poorer OS. Among patients with EV who underwent hepatectomy, multivariate analysis identified ICGR15 >17 % (p = 0.03) as the only independent predictor of poorer OS. There was no significant difference in OS between HCC patients with EV and ICGR15 ≤17.0 % and HCC patients without EV. Ten patients experienced EV bleeding after hepatectomy. Multivariate analysis showed that preoperative endoscopic findings of blue color EV (p = 0.008) and red color sign (p = 0.0005) were independent predictors of EV bleeding in patients with HCC after hepatectomy. Conclusions: These results suggest that HCC patients with EV and ICGR15 ≤17 % may be suitable for surgery, but patients with preoperative endoscopic blue color EV and red color sign need to be managed appropriately.

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