• Felice Giuliante, Francesco Ardito, Antonio D Pinna, Gerardo Sarno, Stefano M Giulini, Giorgio Ercolani, Nazario Portolani, Guido Torzilli, Matteo Donadon, Luca Aldrighetti, Carlo Pulitanò, Alfredo Guglielmi, Andrea Ruzzenente, Lorenzo Capussotti, Alessandro Ferrero, Fulvio Calise, Vincenzo Scuderi, Bruno Federico, and Gennaro Nuzzo.
• Hepato-Biliary Surgery Unit, Department of Surgery, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy. fgiuliante@tm.unicatt.it
• J. Am. Coll. Surg.. 2012 Aug 1;215(2):244-54.

BackgroundThe best treatment for patients with small hepatocellular carcinoma (S-HCC) is still controversial. The aim of this study was to evaluate operative and long-term results after liver resection (LR) for S-HCC, defined as tumor ≤3 cm.Study DesignRetrospective multicenter study of 588 LRs for S-HCC from 8 Italian hepatobiliary surgery units (years 1992 to 2008). Primary outcomes included operative risk. Logistic regression analysis was used to evaluate risk factors for postoperative mortality. Secondary outcomes were overall survival (OS) and disease-free survival (DFS), estimated by the Kaplan-Meier method.ResultsPostoperative mortality was 1.9%, morbidity was 35.7% (major morbidity 7.3%), and blood transfusion rate was 13.8%. Child-Pugh class B and blood transfusions were associated with higher postoperative mortality. Rates of microvascular invasion and microsatellite nodules were 37.0% and 23.1%. After a median follow-up of 38.4 months, 5- and 10-year OS rates were 52.8% and 20.3%, with DFS of 32.4% and 21.7%. Local recurrence rate was 1.4%. Between the years 2000 and 2008, 5-year OS was significantly higher than that between the years 1992 and 1999 (61.9% vs 42.6%; p < 0.001). In multivariable analysis, Child-Pugh class B, portal hypertension, and microsatellite lesions were independently associated with poor OS. Microsatellite lesion was the only variable independently associated with poor DFS.ConclusionsLiver resection for S-HCC has improved over the years, with decreased operative risk. Long-term survival after LR has increased. Despite small tumor size, rates of microsatellite nodules and microvascular invasion are not negligible. Presence of microsatellite lesions was the only variable identified as being associated with poor both OS and DFS.Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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