Journal of Gastrointestinal Surgery

, Volume 21, Issue 3, pp 487–495 | Cite as

Impact of Viral Etiology on Postoperative De Novo Recurrence After Hepatectomy for Hepatocellular Carcinoma in Cirrhotic Patients

  • Kazunari Sasaki
  • Junichi Shindoh
  • Yujiro Nishioka
  • Georgios A. Margonis
  • Toshitaka Sugawara
  • Nikolaos Andreatos
  • Masaji Hashimoto
  • Timothy M. Pawlik
Original Article


Background and Aim

Liver cirrhosis (LC) and hepatocellular carcinoma (HCC) are associated with viral hepatitis, especially hepatitis B virus (HBV) and hepatitis C virus (HCV). Whether differences exist in postoperative de novo carcinogenesis from established cirrhosis according to viral etiology remains unclear.


Data from 313 LC patients with viral hepatitis (HBV-LC, n = 108 and HCV-LC, n = 205) who underwent curative-intent hepatectomy for HCC were retrospectively collected. Clinicopathological characteristics, cumulative recurrence, chronological change of recurrence rate, and predictors of recurrence were analyzed.


Baseline patient characteristics were different among patients with HBV versus HCV as HCC-LC patients had a lower albumin, higher alanine transaminase, and higher incidence of tumor multicentricity (all P < 0.050). The 1-, 3-, and 5-year cumulative recurrence was 16.7, 38.6, and 53.7% in HBV-LC versus 20.8, 52.2, and 71.6% in HCV-LC (P = 0.002) patients, respectively. The postoperative annual recurrence rates of HCV-LC were consistently higher than that of HBV-LC patients. After matching on clinicopathologic characteristics, while recurrence was comparable in the early time period, HCV-LC patients had a 2–5% higher incidence of recurrence compared with HBV-LC patients after 20 months post-resection. On multivariable analysis, HCV infection was an independent predictor of recurrence (HR 1.55; 95% CI 1.13–2.13).


HCV-related LC was associated with a higher postoperative de novo carcinogenesis than HBV-related LC. Establishment of different treatment algorithms as well as follow-up surveillance protocols stratified by viral etiology may be warranted.


Hepatitis C virus Hepatitis B virus Hepatocellular carcinoma Liver cirrhosis Hepatectomy 



The authors thank Dr. Daisuke Morioka for his comments and suggestions, which were of inestimable value for our study.

Compliance with Ethical Standards


We did not receive any funding for this research and publication. None of the authors have anything to disclose.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2016

Authors and Affiliations

  • Kazunari Sasaki
    • 1
  • Junichi Shindoh
    • 2
  • Yujiro Nishioka
    • 2
  • Georgios A. Margonis
    • 1
  • Toshitaka Sugawara
    • 2
  • Nikolaos Andreatos
    • 1
  • Masaji Hashimoto
    • 2
  • Timothy M. Pawlik
    • 1
  1. 1.Department of SurgeryThe Johns Hopkins HospitalBaltimoreUSA
  2. 2.Hepatobiliary Surgery Division, Department of Digestive SurgeryToranomon HospitalTokyoJapan

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