Large Hepatocellular Carcinoma: Time to Stop Preoperative Biopsy

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J Am Coll Surg. 2007 Sep;205(3):453-462. Epub 2007 Jun 27.

Large Hepatocellular Carcinoma: Time to Stop Preoperative Biopsy.

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

Lodge JP.

Hepatobiliary and Transplant Unit, St ’s University Hospital, Leeds,

United Kingdom.

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.

PMID: 17765162 [PubMed - as supplied by publisher]

_________________________________________________________________

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[Guest guest]

J Am Coll Surg. 2007 Sep;205(3):453-462. Epub 2007 Jun 27.

Large Hepatocellular Carcinoma: Time to Stop Preoperative Biopsy.

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

Lodge JP.

Hepatobiliary and Transplant Unit, St ’s University Hospital, Leeds,

United Kingdom.

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.

PMID: 17765162 [PubMed - as supplied by publisher]

_________________________________________________________________

Can you find the hidden words?  Take a break and play Seekadoo!

http://club.live.com/seekadoo.aspx?icid=seek_hotmailtextlink1