Factors associated with early cancer-related death after curative hepatectomy for solitary small hepatocellular carcinoma without macroscopic vascular invasion.

BACKGROUND

Unexpected early cancer-related death (ECRD) within 2 years due to recurrence after curative hepatectomy for solitary small (<5 cm) hepatocellular carcinoma without macroscopic vascular invasion (SSHCC) is occasionally observed.

METHOD

A total of 415 patients were enrolled (19 patients with ECRD and 396 patients with non-ECRD) to elucidate the risk factors of ECRD after curative hepatectomy for SSHCC. They were initially compared by limiting variables to preoperative factors to reveal predictors that could enable the modification of primary treatment. Subsequently, the same analysis was performed with all variables, including perioperative and histological factors.

RESULTS

In the preoperative factors, tumor size > 3 cm and elevation of tumor marker level were independent predictors of ECRD. In the analysis with all variables, excessive intraoperative blood loss, poor differentiation, and microscopic vascular invasion were predictors of ECRD. In the recurrence patterns, 79% of ECRD presented as advanced (four or more lesions) or extra-hepatic recurrence, whereas these accounted for 18% in the non-ECRD.

CONCLUSION

Excessive blood loss during the operation and histopathological findings of microscopic vascular invasion and poor differentiation are predictive factors of cancer-related death within 2 years of a hepatectomy for SSHCC.