Surgical Outcomes and Recurrence Management in Borderline Resectable Hepatocellular Carcinoma: Implications for
Koichiro Haruki1, Kenei Furukawa1, Munetoshi Akaoka1
1Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery The Jikei University School of Medicine Minato-ku Tokyo Japan.
Annals of Gastroenterological Surgery
|July 3, 2026
Summary
Borderline resectable hepatocellular carcinoma (BR-HCC) shows high recurrence rates. Active salvage treatments for BR-HCC recurrence can improve survival, emphasizing multidisciplinary management.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Hepatocellular Carcinoma Research
Background:
- The classification of hepatocellular carcinoma (HCC) into resectable and borderline resectable (BR) categories necessitates refined treatment strategies for BR cases.
- This study focuses on evaluating surgical outcomes and identifying prognostic factors in BR-HCC, aiming to optimize multidisciplinary management for recurrence.
Purpose of the Study:
- To assess surgical outcomes and prognostic factors in borderline resectable hepatocellular carcinoma (BR-HCC).
- To re-evaluate multidisciplinary approaches for managing recurrence in BR-HCC patients.
Main Methods:
- Analysis of 433 patients undergoing primary hepatic resection for HCC (2000-2023).
- Classification of patients into R, BR1, and BR2 groups based on the Expert Consensus Statement 2023.
- Multivariate Cox proportional hazard models utilized to identify prognostic factors for disease-free and overall survival in BR (BR1 + BR2) patients.
Main Results:
- Among 70 BR-HCC patients, 5-year overall survival was 53% for BR1 vs. 22% for BR2 (p=0.06).
- Independent predictors of recurrence included up-to-7 out status and lymph node metastasis (p<0.001); anatomical resection improved disease-free survival (p=0.02).
- Predictors of overall survival included older age, Child-Pugh B, up-to-7 out status, macrovascular invasion, and lymph node metastasis (all p<0.05). BR2 subgroup experienced more frequent early recurrence (p=0.006).
- Recurrence occurred in 89% of BR-HCC patients; surgical resection or radiofrequency ablation for recurrence improved survival (p<0.001).
Conclusions:
- BR1 and BR2-HCC are aggressive subtypes with high recurrence and poor prognosis, particularly with adverse features like up-to-7 out status, lymph node metastasis, and macrovascular invasion.
- Prompt salvage treatments, including surgical resection or radiofrequency ablation, can enhance survival for recurrent BR-HCC.
- Multidisciplinary management is crucial for optimizing outcomes in borderline resectable hepatocellular carcinoma.
