Early and Long Term Results of Hepatic Resection for Hepatocellular Carcinoma (HCC) at a Tertiary Care Centre in India

Abstract

Background: There is limited data on the management of hepatocellular carcinoma (HCC) with hepatic resection in India. We did an audit of patients with HCC who were operated upon so as to generate data specific to the Indian population. Methods: The records of all patients who underwent hepatic resection for HCC in the Department of Gastro-Intestinal Surgery, All India Institute of Medical Sciences, New Delhi were reviewed. The relevant perioperative data were extracted from a prospectively maintained database. Statistical analysis was done using SPSS software version 17.0. Results: Between January 1987 and December 2013, 81 patients’ 70 males’ median age: 52 (14–80) years underwent hepatic resection for HCC. Of these 23 (28%) were cirrhotic and 36 (44%) had hepatitis B. Hepatitis B was significantly more common in cirrhotics 74% vs 34%; P = 0.001. Most patients had locally advanced disease at presentation, vascular tumor thrombus in 10 (12%). Anatomical resection was done in 61 (75%) patients, 32 right hepatectomies, 14 left hepatectomies, 8 extended right hepatectomies, 4 left lateral segmentectomies, 1 extended left hepatectomy and 1 central hepatectomy and1bi-segmentectomy. Overall in-hospital mortality was 13 (16%) cirrhotics: 5 (22%) non-cirrhotics: 8 (14%). Grade III-V complications occurred in 25 (31%) patients cirrhotic: 48% vs non-cirrhotic: 24%; p = 0.037. The median time to recurrence was 10 months and most 85% occurred within 1 year. The overall recurrence free survival at 1-, 3- and 5-years was 48%, 39% and 34%, respectively. Conclusion: A high proportion of patients with HCC have hepatitis B infection and most are locally advanced at presentation. Despite this surgical resection provides a chance for long term recurrence-free survival in them.