title: Hepatic resection for predominantly large size hepatocellular carcinoma: Early and long-term results from a tertiary care center in India.
abstract: OBJECTIVE
  There are no large series on hepatic resection for hepatocellular carcinoma (HCC) from India. We present the results of consecutive patients of HCC treated with hepatic resection at a tertiary care center in India.
  
  
  METHODS
  The records of all patients who underwent hepatic resection for HCC in the Department of Gastrointestinal Surgery, All India Institute of Medical Sciences (New Delhi), were reviewed. The relevant perioperative and follow up data were extracted from a prospectively maintained database.
  
  
  RESULTS
  Between January 1987 and December 2013, 81 patients [71 males; mean age: 49.2 ± 15.6 years] underwent hepatic resection for HCC. Of these, 23 (28 %) were cirrhotic and 36 (49 %) had hepatitis B. Hepatitis B was significantly more common in cirrhotic (77 % vs. 37 %; p = 0.001). Most patients had locally advanced disease at presentation [tumor size ≥10 cm in 61 (75 %); vascular tumor thrombus in 10 (12 %)]. Anatomical resection was done in 61 (75 %) including 56 major hepatic resections (≥3 segments). Overall in-hospital mortality was 13 (16 %) [cirrhotic 5 (22 %) vs. noncirrhotic 8 (14 %), p = 0.503]. Grade III-V complications (modified Clavien-Dindo classification) occurred in 25 (31 %) patients (cirrhotic 48 % vs. noncirrhotic 24 %; p = 0.037). Follow up information was available for 51 (75 %) patients. The median time to recurrence was 12 months, and most (86 %) occurred within 1 year. The recurrence-free survival at 1, 3, and 5 years was 48 %, 40 %, and 36 %, respectively. Positive resection margin and vascular invasion were significantly associated with very poor prognosis.
  
  
  CONCLUSIONS
  Majority of Indian HCC patients present with locally advanced disease. Despite this, surgical resection provides a chance for long-term recurrence-free survival in a third of them.
authors: Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, 110 029, India. rajeshpanwar81@gmail.com.
authors: Rajesh
authors: R
authors: Panwar
authors: Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, 110 029, India.
authors: Sujoy
authors: S
authors: Pal
authors: Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, 110 029, India.
authors: Nihar R
authors: NR
authors: Dash
authors: Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India.
authors: Shalimar
authors: Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, 110 029, India.
authors: Peush
authors: P
authors: Sahni
authors: Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India.
authors: Subrat K
authors: SK
authors: Acharya
authors: Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, 110 029, India.|Department of Surgery, Launceston General Hospital, Charles St Launceston, Tasmania, Australia.
authors: Girisk K
authors: GK
authors: Pande
authors: Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, 110 029, India.|HPB Surgery, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India.
authors: Tushar K
authors: TK
authors: Chattopadhyay
authors: Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, 110 029, India.|Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India.
authors: Samiran
authors: S
authors: Nundy
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000401:mortality* / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors
keywords: Hepatic resection; Hepatocellular carcinoma; Morbidity; Mortality; Recurrence-free survival