Liver resection for hepatocellular carcinoma: personal experiences in a series of 1330 consecutive cases in China

Background

Liver resection to treat early stage hepatocellular carcinoma (HCC) is widely practised but surgery for intermediate and advanced stages of HCC is not included in the treatment algorithm of the Barcelona Clinic Liver Cancer, which has been adopted in official guidelines; nevertheless, resection beyond early stages is frequently undertaken and documented.

Methods

Between January 2001 and December 2014, all the HCC patients who underwent liver resection for the first time by Dr Yiqun Yan and his surgical team were enrolled. Clinical data were prospectively collected as well as the follow-up results.

Results

A total of 1330 consecutive patients were included in the study, of which 452 (34.0%) suffered complications after liver resection with a mortality of 0.7%. The overall survival rates at 1-, 3- and 5-year were 91.2, 63.3 and 36.9%, respectively, while the disease-free survival rates at 1-, 3- and 5-year were 67.7, 33.7 and 13.8%, respectively. Cases were classified into Barcelona Clinic Liver Cancer stage A (548 patients, 41.2%), stage B (613 patients, 46.1%) and stage C (169 patients, 12.7%). The overall survival time at 5-year were 49.8, 32.8 and 10.6%, respectively, in patients with stage A, B and C tumours.

Conclusion

Liver resection to treat HCC is safe in patients with preserved liver function and good functional status. Liver resection should be the first line therapy in patients with single (regardless of tumour size) and resectable 2–3 tumours as well as vascular tumour thrombus if the tumour thrombus does not invade the major trunks.

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