Liver Surgery Unit, Department of Surgery, University of Milan-School of Medicine, Humanitas Clinical and Research Center, Rozzano, Milan, Italy Service de Chirurgie Hépatique et Pancréatique, Hôpital Beaujon, University of Paris VII, Clichy Cedex, Paris, France Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan Department HPB and Digestive Surgery, Ospedale Mauriziano "Umberto I", Turin, Italy Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX Department of Surgery and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD General Surgery and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Gascón, Buenos Aires, Argentina Biostatistics Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy Japanese Red Cross Medical Center, Tokyo, Japan.
OBJECTIVE: The aim of this study was to investigate in a retrospective setting the patients' profile and results of those undergoing surgery for hepatocellular carcinoma (HCC) in high-volume surgical centers throughout the world. BACKGROUND: Whether surgery for HCC is a suitable approach and for which subset of patients is still controversial. The EASL/AASLD (European Association for the Study of Liver Disease/American Association for the Study of Liver Disease) guidelines, based on the Barcelona Clinic Liver Cancer (BCLC) classification, leave little room for hepatic resection; inversely, other reports promote its wider application.
METHODS: On the basis of the network "Hepatocellular Carcinoma: Eastern & Western Experiences," data for 2046 consecutive patients resected for HCC in 10 centers were collected. According to the BCLC classification, 1012 (50%) were BCLC 0-A, 737 (36%) BCLC B, and 297 (14%) BCLC C. Analysis of overall survival and disease-free survival and multivariate analysis of prognostic factors were performed.
FINDINGS.: The 90-day mortality rate was 2.7%. Overall morbidity was 42%. After a median follow-up of 25 months (range, 1-209 months), the 1-, 3-, and 5-year overall survival rates were 95%, 80%, and 61% for BCLC 0-A; 88%, 71%, and 57% for BCLC B; and 76%, 49%, and 38% for BCLC C (P = 0.000). The 1-, 3-, and 5-year disease-free survival rates were as follows: 77%, 41%, and 21% for BCLC 0-A; 63%, 38%, and 27% for BCLC B; and 46%, 28%, and 18% for BCLC C (P = 0.000). The multivariate analysis identified bilirubin, cirrhosis, esophageal varices, tumor size, and macrovascular invasion to be statistical and independent prognostic factors for overall survival.
CONCLUSIONS: This large multicentric survey shows that surgery is in current practice widely applied among patients with multinodular, large, and macrovascular invasive HCC, providing acceptable short- and long-term results and justifying an update of the EASL/AASLD therapeutic guidelines in this sense.