Resectability of hepatocellular carcinoma: evaluation of 333 consecutive cases at a single hepatobiliary specialty center and systematic review of the literature.
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.
Sotiropoulos
Georgios C
GC
Department of General Surgery and Transplantation, University Hospital Essen, Germany.
Lang
Hauke
H
Frilling
Andrea
A
Molmenti
Ernesto P
EP
Paul
Andreas
A
Nadalin
Silvio
S
Radtke
Arnold
A
Brokalaki
Eirini I
EI
Saner
Fuat
F
Hilgard
Philip
P
Gerken
Guido
G
Broelsch
Christoph E
CE
Malagò
Massimo
M
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