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Results of a Prospective Analysis

Guido Torzilli, MD, PhD; Matteo Donadon, MD; Matteo Marconi, MD; Angela Palmisano, MD; Daniele Del Fabbro, MD; Antonino Spinelli, MD; Florin Botea, MD; Marco Montorsi, MD

Arch Surg. 2008;143(11):1082-1090.

Hypothesis  Using an algorithm for selection of patients with hepatocellular carcinoma (HCC) for surgery, Barcelona Clinic Liver Cancer (BCLC) classification stage B and stage C disease is not a contraindication.

Design  Prospective cohort study.

Setting  University tertiary care hospital.

Patients  Among 163 consecutive patients with HCC, 120 (73.6%) underwent surgery; 113 of 120 (94.2%) underwent resection. Of 113 patients, 61 (54.0%) had BCLC stage 0 or A disease, 24 (21.2%) had stage B disease, and 28 (24.8%) had stage C disease.

Interventions  Surgical strategy was based on the relationship of the tumor to the intrahepatic vascular structures on intraoperative ultrasonography.

Main Outcome Measures  Mortality, morbidity, rate of cut edge local recurrences, and long-term outcome were evaluated. P < .05 was considered statistically significant.

Results  Hospital mortality was 0.9%. The overall morbidity was 27.4%, and major morbidity was 3.5%. After a median follow-up of 24 months (range, 1-65 months), there was no cut edge recurrence. For patients with BCLC stages 0 or A, B, and C disease, the 3-year overall survival rates were 81%, 67%, and 74%, respectively (P =.24); the 3-year disease-free survival rates were 30%, 35%, and 15%, respectively (P =.85); and the 3-year hepatic disease-free survival rates were 39%, 44%, and 17%, respectively (P =.79).

Conclusions  Patients with BCLC stage B and stage C HCC can tolerate hepatic resection with low mortality, acceptable morbidity, and survival benefits if resection is performed under strict intraoperative ultrasonographic guidance. These results should prompt revision of the BCLC recommendations.

Author Affiliations: Third Department of Surgery, University of Milan School of Medicine, Istituto Clinico Humanitas Istituto Di Ricovero e Cura a Carattere Scientifico, Rozzano, Milan, Italy.