11. tbl. 103. árg. 2017

Surgical treatment of hepatocellular carcinoma at Landspitali The National University Hospital of Iceland 1993 – 2012

Skurðmeðferð lifrarfrumukrabbameins á Landspítala 1993-2012

Introduction: Hepatocellular carcinoma (HCC) is one of the most common cancers in the world. The incidence in Iceland is very low probably due to a low prevalence of cirrhosis. The only curative treatment is surgery, either transplant or resections, but only about 30% of patients are operable at the time of diagnosis. The aim of this study was to determine the number of patients who undergo liver resection due to HCC and to investigate outcomes after surgery at Landspitali University Hospital in Iceland.

Material and methods: A retrospective study of all HCC patients, 18 years of age or older, who underwent surgical resection at Landspitali University Hospital from January 1st 1993 to December 31st 2012. Data was collected from clinical records. Descriptive statistical analysis was used.

Results: During the time period 22 patients were operated with a liver resection and of those patients 12 (55%) had a major hepatectomy. 105 individuals in total were diagnosed with HCC in the time period, six patients had transplantation which results in 28 operations (27%). The average size of the tumors was 8.5 cm (3-22). Four individuals had cirrhosis. The frequency of intra-operative complications was 23% and post-operative complications 32% (Clavien-Dindo grade III and IV). A total of three individuals needed reoperation. The 30 day mortality rate was 0%. Twelve (55%) individuals were diagnosed with recurrence during the research period and eleven died. The one year mortality rate was 23%.

Conclusion: The proportion of operable individuals with HCC in Iceland is low, few of whom have cirrhosis or other chronic liver disease. The mortality rate is comparable to other researches but the frequency of serious complications is higher probably due to tumor size.

Table I: Child-Pugh score for cirrhosis: A 5-6 points, B 7-9 points and C 10-15 points.

Table II: The Clavien-Dindo classification of surgical complications24.

Table III: Symptoms of patients operated for HCC.

Table IV: Postoperative complications after hepatectomy; mild (Clavien-Dindo grade 1-2) and major (flokkur 3-5).

Figure I: Segmentation of the liver according to the Couinaud classification.

Figure II: Twentee two patients were incluced in the study.

Figure III: Clavien-Dindo classification of surgical complications.









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