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Hepatocellular carcinoma surgical and oncological trends in a national multicentric population: the HERCOLES experience

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Abstract

Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63–75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5 years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power.

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Data availability

Data are available after study group’s approval.

Code availability

Analysis were performed by R software (v 3.6.2), the script is available upon request.

References

  1. Gerbes A, Zoulim F, Tilg H et al (2018) Gut roundtable meeting paper: selected recent advances in hepatocellular carcinoma. Gut 67:380–388

    Article  CAS  PubMed  Google Scholar 

  2. European Association for the Study of the Liver (2018) EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol 69:182–236

    Article  Google Scholar 

  3. Strasberg SM (2005) Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12:351–355

    Article  PubMed  Google Scholar 

  4. Azoulay D, Eshkenazy R, Andreani P et al (2005) In situ hypothermic perfusion of the liver versus standard total vascular exclusion for complex liver resection. Ann Surg 241:277–285

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chan K-M, Lee C-F, Wu T-J et al (2012) Adverse outcomes in patients with postoperative ascites after liver resection for hepatocellular carcinoma. World J Surg 36:392–400

    Article  PubMed  Google Scholar 

  6. Balzan S, Belghiti J, Farges O et al (2005) The “50-50 Criteria” on Postoperative Day 5. Ann Surg 242:824–829

    Article  PubMed  PubMed Central  Google Scholar 

  7. White DL, Thrift AP, Kanwal F et al (2017) Incidence of hepatocellular carcinoma in all 50 United States, from 2000 through 2012. Gastroenterology 152:812–820.e5

    Article  PubMed  Google Scholar 

  8. El-Serag HB (2012) Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology 142:1264–1273.e1

    Article  PubMed  Google Scholar 

  9. Cucchetti A, Ross LF, Thistlethwaite JR Jr et al (2015) Age and equity in liver transplantation: an organ allocation model. Liver Transpl 21:1241–1249

    Article  PubMed  Google Scholar 

  10. Sangiovanni A, Prati GM, Fasani P et al (2006) The natural history of compensated cirrhosis due to hepatitis C virus: a 17-year cohort study of 214 patients. Hepatology 43:1303–1310

    Article  PubMed  Google Scholar 

  11. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348:1625–1638

    Article  PubMed  Google Scholar 

  12. Chen C-L, Yang H-I, Yang W-S et al (2008) Metabolic factors and risk of hepatocellular carcinoma by chronic hepatitis B/C infection: a follow-up study in Taiwan. Gastroenterology 135:111–121

    Article  CAS  PubMed  Google Scholar 

  13. Viganò L, Conci S, Cescon M et al (2015) Liver resection for hepatocellular carcinoma in patients with metabolic syndrome: a multicenter matched analysis with HCV-related HCC. J Hepatol 63:93–101

    Article  PubMed  Google Scholar 

  14. Younossi ZM, Blissett D, Blissett R et al (2016) The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe. Hepatology 64:1577–1586

    Article  PubMed  Google Scholar 

  15. Fedeli U, Grande E, Grippo F, Frova L (2017) Mortality associated with hepatitis C and hepatitis B virus infection: a nationwide study on multiple causes of death data. World J Gastroenterol 23:1866–1871

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bertuccio P, Turati F, Carioli G et al (2017) Global trends and predictions in hepatocellular carcinoma mortality. J Hepatol 67:302–309

    Article  PubMed  Google Scholar 

  17. Global Burden of Disease Liver Cancer Collaboration, Akinyemiju T, Abera S et al (2017) The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level: results from the Global Burden of Disease Study 2015. JAMA Oncol 3:1683–1691

    Article  PubMed Central  Google Scholar 

  18. Zheng Y-W, Wang K-P, Zhou J-J et al (2018) Portal hypertension predicts short-term and long-term outcomes after hepatectomy in hepatocellular carcinoma patients. Scand J Gastroenterol 53:1562–1568

    Article  PubMed  Google Scholar 

  19. Ishizawa T, Hasegawa K, Aoki T et al (2008) Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology 134:1908–1916

    Article  PubMed  Google Scholar 

  20. Berzigotti A, Reig M, Abraldes JG et al (2015) Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review and meta-analysis. Hepatology 61:526–536

    Article  PubMed  Google Scholar 

  21. Forner A, Gilabert M, Bruix J, Raoul J-L (2015) Heterogeneity of intermediate-stage HCC necessitates personalized management including surgery. Nat Rev Clin Oncol 12:10–10

    Article  PubMed  Google Scholar 

  22. Vitale A, Burra P, Frigo AC et al (2015) Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages: a multicentre study. J Hepatol 62:617–624

    Article  PubMed  Google Scholar 

  23. Citterio D, Facciorusso A, Sposito C et al (2016) Hierarchic interaction of factors associated with liver decompensation after resection for hepatocellular carcinoma. JAMA Surg 151:846–853

    Article  PubMed  Google Scholar 

  24. Zhang X-P, Wang K, Li N et al (2017) Survival benefit of hepatic resection versus transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a systematic review and meta-analysis. BMC Cancer 17:902

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Torzilli G, Belghiti J, Kokudo N et al (2013) A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations? An observational study of the HCC East-West Study Group. Ann Surg 257:929–937

    Article  PubMed  Google Scholar 

  26. Forner A, Reig M, Bruix J (2018) Hepatocellular carcinoma. Lancet 391:1301–1314

    Article  PubMed  Google Scholar 

  27. Bruix J, Sherman M, Global Burden of Disease Liver Cancer Collaboration (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022

    Article  PubMed  Google Scholar 

  28. Zhang X-P, Gao Y-Z, Chen Z-H et al (2019) An Eastern Hepatobiliary Surgery Hospital/portal vein tumor thrombus scoring system as an aid to decision making on hepatectomy for hepatocellular carcinoma patients with portal vein tumor thrombus: a multicenter study. Hepatology 69:2076–2090

    Article  PubMed  Google Scholar 

  29. Cheng S, Chen M, Cai J, National Research Cooperative Group for Diagnosis and Treatment of Hepatocellular Carcinoma with Tumor Thrombus (2017) Chinese expert consensus on multidisciplinary diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus:2016 edition. Oncotarget 8:8867–8876

    Article  PubMed  Google Scholar 

  30. Kokudo T, Hasegawa K, Matsuyama Y et al (2016) Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion. J Hepatol 65:938–943

    Article  PubMed  Google Scholar 

  31. Shi J, Lai ECH, Li N et al (2011) A new classification for hepatocellular carcinoma with portal vein tumor thrombus. J Hepatobiliary Pancreat Sci 18:74–80

    Article  PubMed  Google Scholar 

  32. Chok KSH, Cheung TT, Chan SC et al (2014) Surgical outcomes in hepatocellular carcinoma patients with portal vein tumor thrombosis. World J Surg 38:490–496

    Article  PubMed  Google Scholar 

  33. Wang K, Guo WX, Chen MS et al (2016) Multimodality treatment for hepatocellular carcinoma with portal vein tumor thrombus: a large-scale, multicenter, propensity matching score analysis. Medicine 95:e3015

    Article  PubMed  PubMed Central  Google Scholar 

  34. Aldrighetti L, Ratti F, Cillo U et al (2017) Diffusion, outcomes and implementation of minimally invasive liver surgery: a snapshot from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery) Registry. Updates Surg 69:271–283

    Article  PubMed  Google Scholar 

  35. Ciria R, Cherqui D, Geller DA et al (2016) Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 263:761–777

    Article  PubMed  Google Scholar 

  36. He J, Amini N, Spolverato G et al (2015) National trends with a laparoscopic liver resection: results from a population-based analysis. HPB 17:919–926

    Article  PubMed  PubMed Central  Google Scholar 

  37. Famularo S, Di Sandro S, Giani A et al (2018) Long-term oncologic results of anatomic vs. parenchyma-sparing resection for hepatocellular carcinoma. A propensity score-matching analysis. Eur J Surg Oncol 44:1580–1587

    Article  PubMed  Google Scholar 

  38. Marubashi S, Gotoh K, Akita H et al (2015) Anatomical versus non-anatomical resection for hepatocellular carcinoma. Br J Surg 102:776–784

    Article  CAS  PubMed  Google Scholar 

  39. Calise F, Giuliani A, Sodano L et al (2015) Segmentectomy: is minimally invasive surgery going to change a liver dogma? Updates Surg 67:111–115

    Article  PubMed  Google Scholar 

  40. Franken C, Lau B, Putchakayala K, Andrew DiFronzo L (2014) Comparison of short-term outcomes in laparoscopic vs open hepatectomy. JAMA Surg 149:941

    Article  PubMed  Google Scholar 

  41. van Mierlo KMC, Schaap FG, Dejong CHC, Olde Damink SWM (2016) Liver resection for cancer: new developments in prediction, prevention and management of postresectional liver failure. J Hepatol 65:1217–1231

    Article  PubMed  Google Scholar 

  42. Sotiropoulos GC, Prodromidou A, Kostakis ID, Machairas N (2017) Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma. Updates Surg 69:291–311

    Article  PubMed  Google Scholar 

  43. Rodríguez-Perálvarez M, Luong TV, Andreana L et al (2013) A systematic review of microvascular invasion in hepatocellular carcinoma: diagnostic and prognostic variability. Ann Surg Oncol 20:325–339

    Article  PubMed  Google Scholar 

  44. Portolani N, Baiocchi GL, Molfino S et al (2014) Microvascular infiltration has limited clinical value for treatment and prognosis in hepatocellular carcinoma. World J Surg 38:1769–1776

    Article  PubMed  Google Scholar 

  45. Meniconi RL, Komatsu S, Perdigao F et al (2015) Recurrent hepatocellular carcinoma: a Western strategy that emphasizes the impact of pathologic profile of the first resection. Surgery 157:454–462

    Article  PubMed  Google Scholar 

  46. Kondili LA, Lala A, Gunson B et al (2007) Primary hepatocellular cancer in the explanted liver: outcome of transplantation and risk factors for HCC recurrence. Eur J Surg Oncol 33:868–873

    Article  CAS  PubMed  Google Scholar 

  47. Raoul J-L (2008) Natural history of hepatocellular carcinoma and current treatment options. Semin Nucl Med 38:S13–S18

    Article  PubMed  Google Scholar 

  48. Llovet JM, Schwartz M, Mazzaferro V (2005) Resection and liver transplantation for hepatocellular carcinoma. Semin Liver Dis 25:181–200

    Article  PubMed  Google Scholar 

  49. Yang X-D, Pan L-H, Wang L et al (2015) Systematic review of single large and/or multinodular hepatocellular carcinoma: surgical resection improves survival. Asian–Pac J Cancer Prev 16:5541–5547

    Article  PubMed  Google Scholar 

  50. Karaman B, Battal B, Sari S, Verim S (2014) Hepatocellular carcinoma review: current treatment, and evidence-based medicine. World J Gastroenterol 20:18059–18060

    Article  PubMed  PubMed Central  Google Scholar 

  51. Xu X-L, Liu X-D, Liang M, Luo B-M (2018) Radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma: systematic review of randomized controlled trials with meta-analysis and trial sequential analysis. Radiology 287:461–472

    Article  PubMed  Google Scholar 

  52. Ercolani G, Grazi GL, Ravaioli M et al (2003) Liver resection for hepatocellular carcinoma on cirrhosis: univariate and multivariate analysis of risk factors for intrahepatic recurrence. Ann Surg 237:536–543

    PubMed  PubMed Central  Google Scholar 

  53. Roayaie S, Obeidat K, Sposito C et al (2013) Resection of hepatocellular cancer ≤ 2 cm: results from two Western centers. Hepatology 57:1426–1435

    Article  PubMed  Google Scholar 

  54. Zhou Y, Xu D, Wu L, Li B (2011) Meta-analysis of anatomic resection versus nonanatomic resection for hepatocellular carcinoma. Langenbecks Arch Surg 396:1109–1117

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

HERCOLES GROUP (for indexing): Davide Paolo Bernasconi (Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy); Cristina Ciulli (School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy); Alessandro Giani (School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy), Guido Costa (Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Clinical and Research Center, Rozzano, Milan, Italy); Francesca Ratti 9Hepatobiliary Surgery Division, Ospedale San Raffaele, Milan, Italy); Manuela Bellobono (Hepatobiliary Surgery Unit, Fondazione “Policlinico Universitario A. Gemelli”, Catholic University of the Sacred Heart, Rome, Italy); Francesco Calabrese 9Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy); Elena Cremaschi (HPB Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy); Valerio De Peppo (Division of Hepatobiliary Pancreatic Surgery, IRCCS-Regina Elena National Cancer Institute, Rome, Italy); Alessandro Cucchetti (General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy); Giovanni Lazzari (Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy); Andrea Percivale (HPB Surgical Unit, San Paolo Hospital, Savona, Italy); Michele Ciola (Department of Surgery, Bolzano Central Hospital, Bolzano, Italy); Valentina Sega (Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy); Silvia Frassani (Department of Surgery, Monza Policlinic, Monza, Italy); Antonella Del Vecchio (Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy); Luca Pennacchi (Department of Surgery, L. Sacco Hospital, Milan, Italy); Pio Corleone (Surgical Clinic, University Hospital of Trieste, Trieste, Italy); Davide Cosola (Surgical Clinic, University Hospital of Trieste, Trieste, Italy); Luca Salvador (Hepatobiliary Pancreatic Division, Department of Surgical, Oncological and Gastroenterological Science (DISCOG), Treviso Hospital, Padua University Italy, Padua, Italy); Mauro Montuori (Department of Surgery, Ponte San Pietro Hospital, Bergamo, Italy).

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Authors and Affiliations

  1. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

    Simone Famularo, Francesca Carissimi & Fabrizio Romano

  2. Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Clinical and Research Center, Rozzano, Milan, Italy

    Simone Famularo, Matteo Donadon & Guido Torzilli

  3. Hepatobiliary Surgery Division, Ospedale San Raffaele, Milan, Italy

    Federica Cipriani & Luca Aldrighetti

  4. Hepatobiliary Surgery Unit, Fondazione “Policlinico Universitario A. Gemelli”, Catholic University of the Sacred Heart, Rome, Italy

    Francesco Ardito & Felice Giuliante

  5. Division of Hepatobiliary Pancreatic Surgery, IRCCS-Regina Elena National Cancer Institute, Rome, Italy

    Pasquale Perri & Gian Luca Grazi

  6. HPB Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy

    Maurizio Iaria & Raffaele DallaValle

  7. Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy

    Tommaso Dominioni & Marcello Maestri

  8. Department of Surgery, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy

    Matteo Zanello & Elio Jovine

  9. Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy

    Simone Conci & Andrea Ruzzenente

  10. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

    Sarah Molfino & Gian Luca Baiocchi

  11. General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy

    Giuliano LaBarba & Giorgio Ercolani

  12. HPB Surgical Unit, San Paolo Hospital, Savona, Italy

    Cecilia Ferrari & Guido Griseri

  13. Surgical Clinic, University Hospital of Trieste, Trieste, Italy

    Paola Germani & Paola Tarchi

  14. Department of Surgery, Bolzano Central Hospital, Bolzano, Italy

    Stefan Patauner & Antonio Frena

  15. Department of Surgery, Ponte San Pietro Hospital, Bergamo, Italy

    Enrico Pinotti & Mauro Zago

  16. Hepatobiliary Pancreatic Division, Department of Surgical, Oncological and Gastroenterological Science (DISCOG), Treviso Hospital, Padua University Italy, Padua, Italy

    Enrico Lodo & Giacomo Zanus

  17. Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy

    Marco Garatti & Giuseppe Zimmitti

  18. Department of Surgery, Monza Policlinic, Monza, Italy

    Ivano Sciannamea & Adelmo Antonucci

  19. Department of Surgery, L. Sacco Hospital, Milan, Italy

    Albert Troci & Michele Crespi

  20. Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy

    Maria Conticchio & Riccardo Memeo

  21. Department of General Surgery, ASST Crema, Crema, Italy

    Antonio Floridi

  22. Department of Surgery, ASST Lecco, Lecco, Italy

    Marco Chiarelli & Luca Fumagalli

  23. Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy

    Fabrizio Romano

Authors
  1. Simone Famularo
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  2. Matteo Donadon
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  3. Federica Cipriani
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  4. Francesco Ardito
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  5. Francesca Carissimi
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  6. Pasquale Perri
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  7. Maurizio Iaria
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  8. Tommaso Dominioni
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  27. Adelmo Antonucci
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  28. Giuseppe Zimmitti
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  31. Antonio Frena
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  32. Paola Tarchi
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  36. Andrea Ruzzenente
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  39. Raffaele DallaValle
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  40. Gian Luca Grazi
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  41. Felice Giuliante
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  42. Luca Aldrighetti
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  43. Guido Torzilli
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  44. Fabrizio Romano
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Consortia

HE.RC.O.LE.S. Group

  • Davide Paolo Bernasconi
  • , Cristina Ciulli
  • , Alessandro Giani
  • , Guido Costa
  • , Francesca Ratti
  • , Manuela Bellobono
  • , Francesco Calabrese
  • , Elena Cremaschi
  • , Valerio De Peppo
  • , Alessandro Cucchetti
  • , Giovanni Lazzari
  • , Andrea Percivale
  • , Michele Ciola
  • , Valentina Sega
  • , Silvia Frassani
  • , Antonella Del Vecchio
  • , Luca Pennacchi
  • , Pio Corleone
  • , Davide Cosola
  • , Luca Salvador
  •  & Mauro Montuori

Contributions

SF: conception, literature review, design, analysis plan, development, production figures, and tables, analysis, interpretation, discussion, preparation of the first draft, coordination. MD: conception, literature review, design, analysis plan, analysis, interpretation, discussion, review process, coordination. FC, FA, FC, PP, MI, TD, MZ, SC, SM, GL, CF, PG, SP, EP, EL, MG, IS, AT, MC, AF, MC: design, analysis plan, analysis, interpretation, discussion, preparation of the first draft, data collection and database management. LF, RM, MC, AA, GZ, GZ, MZ, AF, PT, GG, GE, GLB, AR, EJ, MM, RD, GLG, FG, LA: Conception, Design, Analysis Plan, Review process, coordination. GT, FR: conception, design, analysis plan, analysis, interpretation, discussion, review process, coordination. HERCOLES Group (Appendix): literature review, data collection and database management.

Corresponding author

Correspondence to Simone Famularo.

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Research involving human participants and/or animals

The central Ethical Committee review of the protocol deemed that formal approval was not required owing to the retrospective, observational and anonymous nature of this study.

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Informed consent was obtained by each patient enrolled.

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The members of HE.RC.O.LE.S. Group are listed in Acknowledgements.

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Famularo, S., Donadon, M., Cipriani, F. et al. Hepatocellular carcinoma surgical and oncological trends in a national multicentric population: the HERCOLES experience. Updates Surg 72, 399–411 (2020). https://doi.org/10.1007/s13304-020-00733-6

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