Journal of Gastrointestinal Surgery

, Volume 17, Issue 1, pp 66–77 | Cite as

Improved Long-Term Survival after Major Resection for Hepatocellular Carcinoma: A Multicenter Analysis Based on a New Definition of Major Hepatectomy

  • Andreas Andreou
  • Jean-Nicolas Vauthey
  • Daniel Cherqui
  • Giuseppe Zimmitti
  • Dario Ribero
  • Mark J. Truty
  • Steven H. Wei
  • Steven A. Curley
  • Alexis Laurent
  • Ronnie T. Poon
  • Jacques Belghiti
  • David M. Nagorney
  • Thomas A. AloiaEmail author
  • From the International Cooperative Study Group on Hepatocellular Carcinoma
2012 SSAT Plenary Presentation



Advances in the surgical management of hepatocellular carcinoma (HCC) have expanded the indications for curative hepatectomy, including more extensive liver resections. The purpose of this study was to examine long-term survival trends for patients treated with major hepatectomy for HCC.

Patients and Methods

Clinicopathologic data for 1,115 patients with HCC who underwent hepatectomy between 1981 and 2008 at five hepatobiliary centers in France, China, and the USA were assessed. In addition to other performance metrics, outcomes were evaluated using resection of ≥4 liver segments as a novel definition of major hepatectomy.


Major hepatectomy was performed in 539 patients. In the major hepatectomy group, median tumor size was 10 cm (range: 1–27 cm) and 22 % of the patients had bilateral lesions. The TNM Stage distribution included 29 % Stage I, 31 % Stage II, 38 % Stage III, and 2 % Stage IV. The postoperative histologic examination indicated that chronic liver disease was present in 35 % of the patients and tumor microvascular invasion was identified in 60 % of the patients. The 90-day postoperative mortality rate was 4 %. After a median follow-up time of 63 months, the 5-year overall survival rate was 40 %. Patients treated with right hepatectomy (n = 332) and those requiring extended hepatectomy (n = 207) had similar 90-day postoperative mortality rates (4 % and 4 %, respectively, p = 0.976) and 5-year overall survival rates (42 % and 36 %, respectively, p = 0.523). Postoperative mortality and overall survival rates after major hepatectomy were similar among the participating countries (p > 0.1) and improved over time with 5-year survival rates of 30 %, 40 %, and 51 % for the years 1981–1989, 1990–1999, and the most recent era of 2000–2008, respectively (p = 0.004). In multivariate analysis, factors that were significantly associated with worse survivals included AFP level >1,000 ng/mL, tumor size >5 cm, presence of major vascular invasion, presence of extrahepatic metastases, positive surgical margins, and earlier time period in which the major hepatectomy was performed.


This multinational, long-term HCC survival analysis indicates that expansion of surgical indications to include major hepatectomy is justified by the significant improvement in outcomes over the past three decades observed in both the East and the West.


Hepatocellular carcinoma Major hepatectomy Multicenter study Long-term survival 



The authors thank Stephanie Deming and Ruth J. Haynes for their assistance with manuscript preparation.

Funding sources

This study was supported, in part, by the National Institutes of Health through MD Anderson's Cancer Center Support Grant, CA016672.

Conflict of interest



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Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Andreas Andreou
    • 1
  • Jean-Nicolas Vauthey
    • 1
  • Daniel Cherqui
    • 2
  • Giuseppe Zimmitti
    • 1
  • Dario Ribero
    • 1
  • Mark J. Truty
    • 1
  • Steven H. Wei
    • 1
  • Steven A. Curley
    • 1
  • Alexis Laurent
    • 2
  • Ronnie T. Poon
    • 3
  • Jacques Belghiti
    • 4
  • David M. Nagorney
    • 5
  • Thomas A. Aloia
    • 1
    Email author
  • From the International Cooperative Study Group on Hepatocellular Carcinoma
  1. 1.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Digestive and Hepatobiliary Surgery and Liver TransplantationHôpital Henri MondorCréteilFrance
  3. 3.Department of SurgeryThe University of Hong Kong, Queen Mary HospitalHong KongChina
  4. 4.Department of SurgeryHôpital BeaujonClichyFrance
  5. 5.Department of Gastroenterologic and General Surgery, Mayo ClinicRochesterUSA

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