title: Liver resection for hepatocellular carcinoma in a hepatitis B endemic area.
abstract: 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.
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand.
authors.forename: Adam St J R
authors.initials: ASJR
authors.lastname: Bartlett
authors.affiliation: 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.
authors.forename: John L
authors.initials: JL
authors.lastname: McCall
authors.affiliation: Department of Surgery, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Koea
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand.
authors.forename: Andrew
authors.initials: A
authors.lastname: Holden
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand.
authors.forename: Mee-Ling
authors.initials: ML
authors.lastname: Yeong
authors.affiliation: Department of Surgery, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Nishanthi
authors.initials: N
authors.lastname: Gurusinghe
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand.
authors.forename: Ed
authors.initials: E
authors.lastname: Gane
mesh_terms: 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