Analysis of Hepatic Resection for Hepatocellular Carcinoma – Is it Possible to Get Optimal Outcomes Despite Limited Resources & Small Numbers?

Introduction: Despite numerous advances, hepatic resection for hepatocellular carcinoma (HCC) remains a major challenge especially in the developing countries. The primary objective of our study was to review the surgical and oncological outcomes of patients who underwent hepatic resection for HCC at our hospital. Methods: Consecutive patients who underwent hepatic resection for HCC at our hospital from 2008 to 2019 were included. The data were analyzed for demographics, liver function, tumor characteristics, perioperative management, surgical and oncological outcomes. Survival analysis were performed using the Kaplan-Meier method, and log rank test was applied to determine the influence of variables on overall and disease free survival. Results: A total of 59 patients underwent hepatic resection for HCC during the study period including 38(64%) males. Majority of the patients had a single lesion (88%), unilobar disease (95%), underlying cirrhosis (75%) and BCLC stage B (73%). Major hepatic resection was performed in 27 (46%) patients. Mean duration of surgery was 288 minutes and mean estimated blood loss was 986 minutes. Postoperative complications developed in 22 (37%) patients including surgical complications in 11 (19%), liver decompensation in 4 (7%) and systemic complications in 9(15%) patients. Overall 30-day mortality was 7%. With a mean follow-up of 2.8 years, disease recurrence was documented in 25 (42%) patients and median overall survival was 45 months. Factors associated with recurrence included cirrhosis (0.008), microvascular invasion (0.001) and BCLC stage B (0.038). Conclusion: Hepatic resection for HCC is a worthwhile treatment option at our setup with surgical and oncological outcomes comparable to the international standards.