Liver resection for hepatocellular carcinoma in a hepatitis B endemic area.
BACKGROUND
Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver. Treatment options include liver resection, tumor ablation, and liver transplantation.


METHODS
We report the results of all patients undergoing partial hepatectomy for HCC with curative intent from a center where all major treatment modalities were available.


RESULTS
A series of 53 patients were identified, of whom 72% had underlying liver disease, mostly chronic hepatitis B infection. Altogether, 57% of patients underwent major resections, of whom 43% had histologically proven cirrhosis. Postoperative morbidity and mortality occurred in 41.5% and 7.5%, respectively. After a median follow-up of 34 months, the survival probabilities at 1, 3, and 5 years were 74.1%, 54.1%, and 42.6%, respectively. A total of 47% developed recurrent disease over the study period with a median disease-free survival of 13.8 months. The probabilities of recurrence at 1, 3, and 5 years were 35.2%, 49.4%, and 55.9%, respectively. Among those who developed recurrence, 76% died, with a median time to death from the time the recurrence was diagnosed of 7.8 months. There was a good association between the CLIP score and survival following liver resection. Multivariate analysis showed that only tumor recurrence and the presence of cirrhosis was a significant determinant of the risk of tumor-related death.


CONCLUSIONS
These findings confirm that with careful patient selection liver resection for HCC can achieve good long-term patient survival and acceptable risks.
Bartlett
Adam St J R
ASJR
Department of Hepatobiliary and Transplant Surgery, New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand.
McCall
John L
JL
Department of Hepatobiliary and Transplant Surgery, New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand. JohnMc@adhb.govt.nz.
Koea
Jonathan B
JB
Department of Surgery, Auckland City Hospital, Auckland, New Zealand.
Holden
Andrew
A
Department of Hepatobiliary and Transplant Surgery, New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand.
Yeong
Mee-Ling
ML
Department of Hepatobiliary and Transplant Surgery, New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand.
Gurusinghe
Nishanthi
N
Department of Surgery, Auckland City Hospital, Auckland, New Zealand.
Gane
Ed
E
Department of Hepatobiliary and Transplant Surgery, New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000601:surgery* / Q000821:virology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000601:surgery* / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009520:New Zealand / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome