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Individualized Approach in the Surgical Management of Hepatocellular Carcinoma: Results from a Greek Multicentre
Georgios K Glantzounis1, Dimitrios Korkolis2, Georgios C Sotiropoulos3
1Hepatobiliary and Pancreatic Surgery (HPB) Unit, Department of Surgery, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, 45500 Ioannina, Greece.
Insights
Aggressive surgical treatment for hepatocellular carcinoma (HCC) shows promising long-term survival, even in advanced stages. Multidisciplinary team discussion is crucial for effective HCC management.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Hepatocellular carcinoma (HCC) is a leading cause of cancer death globally.
- Surgical intervention offers long-term survival for eligible HCC patients.
- Effective HCC management requires complex, often aggressive, treatment strategies.
Purpose of the Study:
- To evaluate the outcomes of aggressive surgical management for HCC in Greece.
- To analyze survival rates and prognostic factors in HCC patients undergoing resection.
- To assess the feasibility of surgical treatment for intermediate and advanced stage HCC.
Main Methods:
- Retrospective multicentre clinical study involving 242 HCC patients.
- Data collection on patient demographics, Barcelona Clinic Liver Cancer (BCLC) staging, and surgical procedures.
- Analysis of postoperative morbidity, mortality, and long-term survival rates.
Main Results:
- The majority of patients were male (79%) with a median age of 71.
- 71.1% of patients were BCLC stage 0-A, with 29% in intermediate/advanced stages (BCLC B/C).
- Five-year survival was 48% overall, 55% for BCLC A, 34% for BCLC B, and 21% for BCLC C. R1/R2 resections and BCLC C stage independently predicted increased mortality.
Conclusions:
- Aggressive surgical resection of HCC can achieve satisfactory long-term survival.
- A significant proportion of resected HCC cases present at intermediate/advanced BCLC stages.
- Individualized patient management through multidisciplinary tumor boards is essential for optimal HCC treatment outcomes.
Abstract:
Background: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the third leading cause of death worldwide. The management of HCC is complex, with surgical treatment providing long-term survival in eligible patients. This study aims to present the experience of aggressive surgical management of HCC in Greece. Methods: This is a retrospective multicentre clinical study with 242 patients. Results: Most patients were male (79%) and had a median age of 71 yrs. According to the most recent BCLC criteria, 172 patients (71.1%) were classified as BCLC 0-A stage, 33 patients (13.6%) were classified as BCLC B, and 37 (15.3%) were classified as BCLC C. A total of 54% of the patients underwent major hepatectomy. Major postoperative morbidity was 15.6%, and the 90-day postoperative mortality rate was 4.5%. The median follow-up was 33.5 months. Three- and five-year overall survival was 65% and 48%, respectively. The median overall survival was 55 months. Significantly, five-year survival was 55% for BCLC A, and 34% and 21% for BCLC B and C, respectively. In univariate analysis, cirrhosis, type of resection (R status), and BCLC stage were associated with overall survival. Multivariate analysis indicated that R1 and R2 resections compared to R0, and BCLC C compared to BCLC 0-A, were independently associated with increased mortality. Conclusions: Aggressive surgical treatment of HCC offers satisfactory long-term survival prospects. A significant percentage (29%) of HCCs that underwent liver resection were of the intermediate and advanced BCLC stage. The management of patients with HCC should be discussed in multidisciplinary tumour board meetings on a case-by-case basis to be more effective.
