Liver resection for HCC outside the BCLC criteria
Surgical resection still remains the mainstay of management of hepatocellular carcinoma (HCC). At present, Barcelona clinic liver cancer (BCLC) staging is the most widely used tool to guide treatment; however, criteria for offering surgery as curative treatment are restrictive. We aimed to evaluate short-term and long-term outcomes of HCC after resection, even for patients outside BCLC criteria for resection.
Data was collected from a prospective database from GI and HPB Department, Tata Memorial Hospital, Mumbai. Study period was from June 2010 to June 2015.
One hundred three patients of HCC were operated during this period, of which 100 underwent complete resection. Patients were staged according to the BCLC classification (BCLC stage A-25, B-64, C-11). Preoperative therapy was administered in 36 (36%) patients. At median follow-up of 21 months, overall 3-year survival for BCLC stages A, B, and C was 55.2, 62.7, and 37.5%, respectively.
In today’s era of liver transplantation, resection (especially for larger tumors) may still be the preferred treatment option, considering problems and difficulties in donor availability, cost, and long waiting list for liver transplant. With evolving modern surgical technique, long-term survival benefit can be achieved with acceptable safety in most BCLC stage B and selected BCLC stage C patients and those who either do not fit into the transplant criteria or cannot afford transplant. Carefully designed trials are required to further elucidate these results.
KeywordsHepatocellular carcinoma Resection Cirrhosis Barcelona clinic liver cancer staging
The authors would like to thank Department of Gastro-intestinal Surgery and Surgical Oncology, Department of Intervention Radiology, Tata Memorial Hospital, Mumbai, India.
Authorship Manish S. Bhandare participated in study conception and design, acquisition of data, analysis and interpretation of data, and drafting of manuscript; Shraddha Patkar participated in study conception and design and acquisition of data; Nitin Shetty, Ashwin Polnaya, and Suyash Kulkarni participated in acquisition of data; Rohit R. Dusane participated in analysis of data; Shailesh V. Shrikhande participated in critical revision of manuscript; and Mahesh Goel participated in study conception and design, drafting of manuscript, and critical revision of manuscript.
Compliance with ethical standards
The data of the present study were collected in the course of common clinical practice, and accordingly, the signed informed consent was obtained from each patient for any surgical and clinical procedure. The study protocol was in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments. Since this was a retrospective study, formal consent for this study is not required and no approval of the institutional research committee was needed.
Conflict of interest
The authors declare that they have no conflict of interest.
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