Objective: R0 resection, Pringle maneuver, intraoperative massive blood loss and perioperative blood transfusion have been definitely recognized to be surgery-related risk factors of recurrence of hepatocellular carcinoma (HCC) in recent years. The aim of this study was to investigate the post-operative risk factors of recurrence of HCC after control of the above mentioned risk factors.
Methods: 288 consecutive HCC patients underwent hepatectomy with selective regional vascular occlusion by the same surgical team. All patients had R0 resection, less than 800 ml blood loss and had no perioperative blood transfusion. The clinical and pathological factors were retrospectively analyzed.
Results: The total 1-year, 3-year and 5-year disease-free survival rate (DFS) was 74.9%, 49.3% and 34.3%, respectively. Univariate analysis showed that serum gamma-glutamyl-transferase rise >55 U/L, AFP > 400 ng/ml, tumor diameter >5 cm, multi-focal lesions, satellite nodules, poor differentiation, microvascular invasion, envelope invasion, postoperative liver insufficiency, preoperative TACE and postoperative TACE were significantly associated with poor DFS. Multivariate Cox analyses revealed that tumor size, satellite nodules, poor differentiation, microvascular invasion and postoperative liver insufficiency were independent prognostic predictors associated with shorter DFS. According to the results of multivariate Cox analysis of 158 cases with at least one risk factor selected from the whole group, further analysis demonstrated that perioperative TACE was not significantly associated with the median DFS (P > 0.05 for all).
Conclusions: Selective regional vascular occlusion may effectively control the surgiury-related risk factors of recurrence of HCC. Tumor features are the main affecting factors of DFS. Preoperative or postoperative TACE do not benefit patients who received curative resection.