Results of resections for hepatocellular carcinoma in a new hepatobiliary unit

Hepatocellular carcinoma (HCC) is the fourth commonest cancer in Singapore. Surgical resection offers the only chance of "cure". Resection tends to be difficult in HCC because of late presentation and concomitant liver cirrhosis. Specialized units with higher volume of operations are known to produce better results. The present review aims to evaluate early results with HCC resection and discuss the correlation between various tumour prognostic factors and the outcome.

The records of 81 consecutive hepatic resections for HCC in the hepatobiliary unit of the Department of General Surgery at the Singapore General Hospital from 1 January 1996 to 31 December 1998 were retrospectively reviewed.

The mean age of the patients was 56.0 +/- 15.4 years. There were more men (M:F: 72:9) and Chinese patients (75 Chinese patients (92.6%); four Malay patients (4.9%); two Indian patients (2.5%)) affected by the disease. Hepatitis B and C carrier status were present in 67.1% (n = 51) and 3.9% (n = 1) of the patients, respectively. Forty-two patients (53.2%) had underlying liver cirrhosis. Twenty-eight patients (34.6%) underwent major hepatectomy and 53 (65.4%) underwent minor hepatectomies. Perioperative mortality was 4.9% (n = 4). The morbidity rate following hepatic resections was 28.4% (n = 23). The median follow up was 21 months (range: 1-52 months). The median survival was 43 months (95% confidence interval (CI): 34.6-51.4 months) after surgery and median time to recurrence was 9.6 months (range: 2-32 months). Overall survival was 79% and 59% at 1 and 3 years, respectively. Disease-free survival was 59% and 30% at 1 and 3 years, respectively. Advance pathological tumour, nodes, metastases (TNM) stage (III and IV), and presence of adjacent organ involvement were risk factors for early recurrence. Advance pathological TNM stage (III and IV) and blood loss of more than 2 L were poor prognostic factors for overall survival.

The results of hepatectomies for HCC in the newly established unit at Singapore General Hospital have been shown to be comparable to other established specialized hepatobiliary units with similar perioperative mortality and morbidity rates.