Abstracts 1998 Digestive Disease Week
#1038
EFFECT OF AN INITIAL POSITIVE MARGIN ON THE PROGNOSIS OF PATIENTS UNDERGOING LIVER RESECTION FOR HEPATOCELLULAR CARCINOMA. G.R. Huffman, A. Uzar, M.A. Choti. Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD.
There is evidence to suggest that intraoperative disruption of liver tumors may lead to an increased incidence of tumor dissemination and ultimately to diminished survival. To address this issue, we examined the long-term overall and disease-free survival of patients undergoing liver resection for hepatocellular carcinoma whose tumors were disrupted by the presence of an initially positive resection margin with subsequent widening of the resection to obtain final microscopically negative margins. Patients included in this study were all persons undergoing curative hepatic resection at the Johns Hopkins Hospital from 1984 to 1996. Our study endpoints were time-to-death and time-to-recurrence after resection. Over this period, 77 patients underwent curative liver resection for hepatocellular carcinoma with adequate follow-up, and were the subject of this analysis. Clinical and pathological data was ascertained prior to the outcome of interest. Overall survival was 75% at one year, 56% at two years and 29% at five years. Significant indicators of poor prognosis (P values<0.05) on univariate analysis included vascular invasion, Stage IVa disease, satellitosis, and both initial and final margin positivity. No difference was seen between close and wide negative resection margins. After adjusting for other significant factors in multivariate analysis, patients having initially positive resection margins who underwent wider resection to obtain negative final margin had a 5-fold increased risk of death (P<0.001) while those having positive final resection margin had a 15-fold increased risk of death (P=0.001) compared to those with an initial negative margin. In summary, patients in whom an initially positive margin was extended to obtain final negative surgical margins had significantly poorer survival than those with initial negative margins, a survival comparable to those with positive final margins. These data suggest that all efforts should be made to achieve an initially negative margin and, in cases in which the initial margin is positive, additional attempts at extending margins may be of limited benefit.
Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.
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