title: Primary liver resection for patients with cirrhosis and hepatocellular carcinoma: the role of surgery in BCLC early (A) and intermediate stages (B).
abstract: OBJECTIVE
  This study aims to report the outcomes following primary liver resection (PLR) in patients with cirrhosis including stratification according to the Barcelona Clinic Liver Cancer (BCLC) classification.
  
  
  METHODS
  Patients with cirrhosis and hepatocellular carcinoma (HCC) who had PLR between 2000 and 2013 were examined. Overall survival (OS), disease-free survival (DFS) and recurrence rate (RR) were analysed. Management after recurrence was reviewed as well as comparison to a series of 116 patients listed directly for liver transplant.
  
  
  RESULTS
  Seventy-one patients underwent PLR. Median follow-up was 40 months. The 1-, 3- and 5-year OS and DFS for the series were 77, 69 and 61 % and 69, 39 and 28 % respectively. Overall recurrence was 59 % (44/71) and only 36 % (15/44) of those patients had a further potentially curative procedure. The 1-3-5-year OS and DFS in the BCLC-A (44 patients) were 86, 78 and 68 % and 78, 48 and 44 % respectively. The RR in BCLC-A was 45 % (20 patients) with half (11 patients) suitable for further treatment with curative intent. The 1-3-5-year OS and DFS in the BCLC-B (17 patients) were 81, 74 and 60 % and 58, 29 and 7 % respectively. The overall RR in BCLC-B was 76 % (13 patients).
  
  
  CONCLUSIONS
  Recurrence following PLR for HCC in patients with cirrhosis is high with only a third of patients suitable for further potentially curative procedures. For patients with BCLC-A (or within Milan criteria), PLR provided a 68 % 5-year OS with 44 % of them free of disease. Surgery can offer satisfactory OS in carefully selected patients in the BCLC-B stage.
authors.affiliation: Department of HPB and Transplant Surgery, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, England, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Bell
authors.affiliation: Department of HPB and Transplant Surgery, Faculty of Medical and Health Sciences at the University of Auckland, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Pandanaboyana
authors.affiliation: Department of HPB and Transplant Surgery, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, England, UK.
authors.forename: J Peter A
authors.initials: JPA
authors.lastname: Lodge
authors.affiliation: Department of HPB and Transplant Surgery, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, England, UK.
authors.forename: K Raj
authors.initials: KR
authors.lastname: Prasad
authors.affiliation: Department of Hepatology, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, England, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jones
authors.affiliation: Department of HPB and Transplant Surgery, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, England, UK. ernest.hidalgo@nhs.net.
authors.forename: Ernest
authors.initials: E
authors.lastname: Hidalgo
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate
keywords: BCLC; HCC; Liver transplant; Primary liver resection