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Master Thesis

Impact de la marge de résection dans la chirurgie pour carcinome hépatocellulaire

Abstract : Context: Surgical management of hepatocellular carcinoma (HCC) represents a major challenge in the multimodal management of patients affected by HCC. Surgical modalities remain controversial, specifically concerning the minimum surgical margin. Objective: To assess the impact of a <10mm or ≥10mm peri-tumor surgical margin in healthy tissue on disease-free survival and overall survival. Material and Methods: Single-center retrospective observational study at the Grenoble Alpes University Hospital Center, between 2004 and 2019 including all patient who underwent a first liver resection surgery for known HCC. Anatomical or non-anatomical resection was performed depending the location of tumor(s) as well as the underlying liver disease. Preoperative, intraoperative and postoperative data were extracted from a local database. Results: One hundred and eighty-nine patients were operated between 2004 and 2019. Disease-free survival at 1, 3 and 5 years was 70%, 44% and 31%. The overall survival at 1, 3 and 5 years was 93%, 78% and 59% respectively. One hundred and twenty-three patients underwent surgery with margin <10mm and 66 patients underwent surgery with margin ≥ 10mm on pathological examination. There was no statistically difference on overall (p = 0.110) and disease-free survival (p = 0.710) between the 2 groups. The univariate and multivariate analyzes did not retain the surgical margin as a risk factor for recurrence or death. Anatomical resection was also not retained as a protective factor. Peritumoral capsula was retain as a protective factor of recurrence [HR 0.49, p = 0.003]. Microvascular tumoral embolism increased recurrence [HR 2.14, p < 0.001] and death [HR 1.81, p = 0.01]. Conclusion: The prevalence of HCC is constantly increasing, with an evolution of multimodal management. Surgical resection, in eligible patients, remains an important place in management, particularly in curative treatment. The ideal, anatomical resection with ideal minimum margins between 10 and 20mm can be tricky or even impossible. The main short and medium term risk is tumor recurrence in the remaining liver parenchyma. We have shown that, at the time of multimodal management of HCC, the oncological results (overall survival or without recurrence) are equivalent in the case of resection without a healthy margin (<10mm) compared to an "ideal" resection with a margin ≥ 10mm. The benefit of a margin ≥10mm seems more prognostic than therapeutic.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03395463
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Submitted on : Friday, October 22, 2021 - 2:14:53 PM
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Ulysse Onde. Impact de la marge de résection dans la chirurgie pour carcinome hépatocellulaire. Médecine humaine et pathologie. 2021. ⟨dumas-03395463⟩

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