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Surgical resection for large hepatocellular carcinoma and those beyond BCLC: systematic review with proposed management algorithm

  • Systematic Review
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

Hepatocellular carcinoma (HCC) accounts for the sixth most common cancer and ranks third in mortality worldwide with inhomogeneity in terms of resection for advanced-stage disease.

Methods

A systematic review of published literature using the PubMed, Medline, and Google Scholar databases from 1995 to 2020 was conducted to identify studies that reported outcomes of resection for solitary HCC > 10 cm, BCLC B/C, and multinodular HCC. Our aim was to assess overall survival for resection, identify poor prognostic factors, and to compare it to trans-arterial chemotherapy (TACE) where data was available.

Results

Eighty-nine articles were included after a complete database search in the systematic review as per our predefined criteria. Analysis revealed a 5-year overall survival of 33.5% for resection of HCC > 10 cm, 41.7% for BCLC B, 23.3% for BCLC C, and 36.6% for multinodular HCC. Peri-operative mortality ranged from 0 to 6.9%. Studies comparing resection versus TACE for BCLC B/C had a survival of 40% versus 17%, respectively.

Conclusion

Our systematic review justifies hepatic resection wherever feasible for hepatocellular carcinomas > 10 cm, BCLC B, BCLC C, and multinodular tumors. In addition, we identified and proposed an algorithm with five poor prognostic criteria in this group of patients who may benefit from adjuvant TACE.

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Authors and Affiliations

  1. Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India

    Saneya Pandrowala, Shraddha Patkar & Mahesh Goel

  2. Hepato-Pancreato-Biliary and Transplant Surgery, University Hospital Birmingham and Birmingham Children’s Hospital, Birmingham, UK

    Darius Mirza

  3. Zen Digestive Disease Center, Zen Hospital, Mumbai, India

    S. K. Mathur

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  1. Saneya Pandrowala
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Contributions

• Study conception and design—Mahesh Goel, S. K. Mathur, Shraddha Patkar.

• Acquisition of data—Saneya Pandrowala and Shraddha Patkar.

• Analysis and interpretation of data—Saneya Pandrowala, Shraddha Patkar, Mahesh Goel, S. K. Mathur.

• Drafting of manuscript—Saneya Pandrowala, Shraddha Patkar, Mahesh Goel, Darius Mirza, S. K. Mathur.

• Critical revision of manuscript— Saneya Pandrowala, Shraddha Patkar, Mahesh Goel, Darius Mirza, S. K. Mathur.

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Pandrowala, S., Patkar, S., Goel, M. et al. Surgical resection for large hepatocellular carcinoma and those beyond BCLC: systematic review with proposed management algorithm. Langenbecks Arch Surg 408, 144 (2023). https://doi.org/10.1007/s00423-023-02881-w

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