A new study suggests that hepatic resection can provide long–term survival benefit in selected patients with non-early-stage hepatocellular carcinoma (HCC).

Researchers at Kaohsiung Medical University (Taiwan) conducted a study involving 478 patients with HCC who underwent liver resection between 1991 and 2006. Of these, 318 were Barcelona Clinical Liver Cancer Classification (BCLC) stage B, and 160 and BCLC stage C. The researchers examined and analyzed factors involved in overall survival and recurrence. The results showed that after a median follow–up of 29.5 months, 304 of the patients had died, putting the cumulative overall survival rate at five years at 46.5% in BCLC stage B patients, and 29.1% in stage C patients.

Multivariate analysis disclosed that serum albumin levels below or equal to 4 g/dL, indocyanine green retention rate at 15 minutes of over 10%, serum creatinine higher than 1.2 mg/dL, multinodularity, Edmondson stage III or IV in tumor cell differentiation, and the presence of macroscopic vascular invasion were independent risk factors of poor overall survival. There were 331 patients with tumor recurrence after resection, and the recurrence rate was less in BCLC stage B than that in BCLC stage C, and was associated with cut margins smaller than one centimeter. The study was published ahead of print on July 3, 2012, in Surgery.

“Hepatic resection can provide long-term survival benefit in selected BCLC stage B or C patients with compensated liver function, especially in those presenting with a single neoplasm without vascular invasion,” concluded lead author Wen-Tsan Chang, MD, and colleagues of the division of hepatobiliary and pancreatic surgery.

The biggest concern about liver resection is that following the operation, the patient can develop liver failure, which occurs if the remaining portion of the liver is inadequate to provide the necessary support for life. Even in carefully selected patients, about 10% of them are expected to die shortly after surgery, usually because of liver failure. In patients with HCC, liver resection is generally limited to patients with one or two small (5 cm or less) tumors and confined to the liver with no invasion of the blood vessels. As a result of these strict guidelines, in practice, very few patients with HCC can undergo liver resection.

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