title: Resectability of hepatocellular carcinoma: evaluation of 333 consecutive cases at a single hepatobiliary specialty center and systematic review of the literature.
abstract: OBJECTIVE
  To determine resectability rates in patients with hepatocellular carcinoma (HCC) evaluated for surgical therapy. Liver resection constitutes a potentially curative treatment for HCC. However, because of the co-existing cirrhosis or the late diagnosis, only a percentage of the patients evaluated can undergo surgery.
  
  
  METHODS
  We evaluated 333 patients with HCC admitted to our center with the intent to treat by means of tumor resection during a 6-year time period.
  
  
  RESULTS
  Surgical resection with curative intent was undertaken in 116 patients (35%). In our series, resectability rates were significantly higher in patients with solitary HCCs (p<0.001), unilobar tumor distribution (p=0.03), and no cirrhosis (p <0.001). Transarterial chemoembolization (TACE) was the most frequent approach for nonresectable cases (18% of patients). A systematic literature review was performed in order to estimate resectability rates at other hepatobiliary centers offering multimodal treatment approaches to HCC. Results showed an overall resectability rate of 30%, with 1808 resections reported in 6108 cases. Resectability rates were significantly higher in Japanese and Eastern series when compared to American and Western studies respectively (p<0.001).
  
  
  CONCLUSIONS
  Treatment strategies for HCC require a multidisciplinary comprehensive approach encompassing surgeons, hepatologists, radiologists, and oncologists. Surgical resection was possible in only 35% and 30% of patients with HCC evaluated for surgical therapy in our series and in the world literature, respectively. TACE was the primary treatment modality for non-resectable cases. A "no therapy" option was chosen in 21% of cases worldwide.
authors.affiliation: Department of General Surgery and Transplantation, University Hospital Essen, Germany.
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
authors.forename: Andrea
authors.initials: A
authors.lastname: Frilling
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.forename: Arnold
authors.initials: A
authors.lastname: Radtke
authors.forename: Eirini I
authors.initials: EI
authors.lastname: Brokalaki
authors.forename: Fuat
authors.initials: F
authors.lastname: Saner
authors.forename: Philip
authors.initials: P
authors.lastname: Hilgard
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagò
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D005260:Female; D005762:Gastroenterology; D006498:Hepatectomy; D006782:Hospitals, Special; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012189:Retrospective Studies; D013503:Surgery Department, Hospital