title: Hepatectomy for stage B and stage C hepatocellular carcinoma in the Barcelona Clinic Liver Cancer classification: results of a prospective analysis.
abstract: OBJECTIVE
  Using an algorithm for selection of patients with hepatocellular carcinoma (HCC) for surgery, Barcelona Clinic Liver Cancer (BCLC) classification stage B and stage C disease is not a contraindication.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  University tertiary care hospital.
  
  
  METHODS
  Among 163 consecutive patients with HCC, 120 (73.6%) underwent surgery; 113 of 120 (94.2%) underwent resection. Of 113 patients, 61 (54.0%) had BCLC stage 0 or A disease, 24 (21.2%) had stage B disease, and 28 (24.8%) had stage C disease.
  
  
  METHODS
  Surgical strategy was based on the relationship of the tumor to the intrahepatic vascular structures on intraoperative ultrasonography.
  
  
  METHODS
  Mortality, morbidity, rate of cut edge local recurrences, and long-term outcome were evaluated. P < .05 was considered statistically significant.
  
  
  RESULTS
  Hospital mortality was 0.9%. The overall morbidity was 27.4%, and major morbidity was 3.5%. After a median follow-up of 24 months (range, 1-65 months), there was no cut edge recurrence. For patients with BCLC stages 0 or A, B, and C disease, the 3-year overall survival rates were 81%, 67%, and 74%, respectively (P =.24); the 3-year disease-free survival rates were 30%, 35%, and 15%, respectively (P =.85); and the 3-year hepatic disease-free survival rates were 39%, 44%, and 17%, respectively (P =.79).
  
  
  CONCLUSIONS
  Patients with BCLC stage B and stage C HCC can tolerate hepatic resection with low mortality, acceptable morbidity, and survival benefits if resection is performed under strict intraoperative ultrasonographic guidance. These results should prompt revision of the BCLC recommendations.
authors.affiliation: Third Department of Surgery, University of Milan, Istituto Clinico Humanitas Istituto Di Ricovero e Cura a Carattere Scientifico, Via Manzoni 56, 20089 Rozzano, Milan, Italy. guido.torzilli@unimi.it
authors.forename: Guido
authors.initials: G
authors.lastname: Torzilli
authors.forename: Matteo
authors.initials: M
authors.lastname: Donadon
authors.forename: Matteo
authors.initials: M
authors.lastname: Marconi
authors.forename: Angela
authors.initials: A
authors.lastname: Palmisano
authors.forename: Daniele
authors.initials: D
authors.lastname: Del Fabbro
authors.forename: Antonino
authors.initials: A
authors.lastname: Spinelli
authors.forename: Florin
authors.initials: F
authors.lastname: Botea
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018579:Patient Selection; D011446:Prospective Studies; D016896:Treatment Outcome