Improved diagnostic imaging and interventional therapies prolong survival after resection for hepatocellular carcinoma in cirrhosis: the university of bologna experience over 10 years

BACKGROUND: With substantial improvements in perioperative care and surgical technique, both mortality and morbidity after liver resection have progressively decreased; however, long-term prognosis is greatly affected by tumor recurrence, which represents the most frequent cause of death. The aim of this study is to analyze the outcome after hepatic resection in the present clinical scenario, where great improvements in diagnostic techniques, surveillance schedules, in other active treatments will potentially have a positive impact on survival. METHODS: Data from 300 consecutive hepatic resections performed on cirrhotic patients in a tertiary-care referral hospital from 1997 and 2008 were reviewed, and survival was calculated for the two periods considered. The first group of patients underwent hepatectomy between 1997 and 2002 (n = 126) and the second group of patients between 2003 and 2008 (n = 174). RESULTS: In the more recent period, tumor selection criteria for resectability included more patients with multinodular tumors so that solitary tumors decreased from 89.7 to 78.7% (P = 0.019); however, the tumor, node, metastasis (TNM) system stage remained unaffected. The 5-year recurrence rate remained similar (67.4 vs. 65.8%; P = 0.836). Despite these features, the 5-year patient survival increased from 52.6 to 65.8% (P = 0.023). This end result was related to a larger proportion of patients with tumor recurrence undergoing repeat resection or salvage transplantation that increased from 22.2 to 36.9% (P = 0.039). CONCLUSIONS: The increased survival is most likely the result of more stringent follow-up as well as increased accuracy in detecting recurrence at earlier stages, and consequently of more chances for potential cure when treating recurrent tumor.