Background: Hepatocellular carcinoma (HCC) is a major global health problem. HCC is difficult to manage
compared to other malignancies due to the underlying liver cirrhosis caused by viral hepatitis. Hepatic resection
and transplantation remain the standard curative therapies for HCC. However, the best treatment strategy for
patients with well-preserved liver function, absence of portal hypertension, and early-stage HCC is debated
Objectives: To assess the outcomes for patients with early stage HCC treated with liver resection, short and long
term results, as well as the effect of different risk factors on the survival of HCC patients treated by liver resection.
Methods: This prospective and retrospective study was carried out between January 2008 and June 2012. 24 early
HCC patients (Child‘s A and B) had liver resection in the Liver unit at Queen Elizabeth Hospital, University of
Birmingham NHS Trust, Birmingham, UK. 21 (87.5%) had right hepatectomy and 3 (12.5%) had left hepatectomy.
7 (29.1%) had extended resection in which more than 4 segments were removed while 17 (70.83%) had nonextended
resection in which the maximum number of resected segments did not exceed 4 segments. Vascular
occlusion (Pringle's maneuver) was done in 5 (20.83 %) cases during the operation. 2 (8.33%) patients had
vascular injury during the operation.
Results: 24 patients (17 males and 7 females) had liver resection for HCC. Their age ranged from 34.4 years to
86.6 years with a mean of 71.37 ± 14.13 years. Fibrosis (5 patients, 20. 83 %) was the most common underlying
liver disease. .Cirrhosis was found in 8 (33.33%) patients. Following liver resection, 2 (8.3 %) patients died during
the first month after surgery, one of them was the result of hepatic insufficiency and the other had portal vein
thrombosis followed by multi-organ failure. 7 (29.16 %) patients had post-operative complications in the form of
either pleural effusion, pulmonary infection, bile leak from the cut surface of the liver or confusion and they were
dealt with accordingly the recurrence free survival was 12.26 ± 9.18 months and the overall survival was 13.76 ±
9.89 months. The one year overall survival was 68.42 % and the 2 year overall survival was 46.15 %. During
follow up time recurrence was detected in two patients one was within the first year and the other was after one
year, one was still alive at the end of the study and the other died within two months from the detection of
recurrence. Patients who had vascular injury to any of the major hepatic vessels intra-operatively showed
significantly lower overall and recurrence free survival (P =0.02 and P=0.004, respectively) than patients who had
no vascular injury.
Conclusion Surgical resection should remain the first line of therapy for patients with early stage HCC and
compensated liver function.