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Primary liver resection for patients with cirrhosis and hepatocellular carcinoma: the role of surgery in BCLC early (A) and intermediate stages (B)

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Abstract

Aim

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).

Conclusion

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.

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Authors and Affiliations

  1. Department of HPB and Transplant Surgery, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF, England, UK

    Richard Bell, J. Peter A. Lodge, K Raj Prasad & Ernest Hidalgo

  2. Department of HPB and Transplant Surgery, Faculty of Medical and Health Sciences at the University of Auckland, Auckland City Hospital, Auckland, New Zealand

    Sanjay Pandanaboyana

  3. Department of Hepatology, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF, England, UK

    Rebecca Jones

Authors
  1. Richard Bell
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  2. Sanjay Pandanaboyana
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  3. J. Peter A. Lodge
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  4. K Raj Prasad
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  5. Rebecca Jones
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  6. Ernest Hidalgo
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Corresponding author

Correspondence to Ernest Hidalgo.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflicts of interest.

Funding

There are no sources of funding to declare for any of the authors.

Informed consent

Informed consent was obtained prior to surgery from all individuals that were included in the study.

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Bell, R., Pandanaboyana, S., Lodge, J.P.A. et al. Primary liver resection for patients with cirrhosis and hepatocellular carcinoma: the role of surgery in BCLC early (A) and intermediate stages (B). Langenbecks Arch Surg 402, 575–583 (2017). https://doi.org/10.1007/s00423-016-1475-3

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  • DOI: https://doi.org/10.1007/s00423-016-1475-3

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