Hepatocellular carcinoma from diagnosis to treatment: 15 years of challenges and modification of resection strategies

Background: Hepatocellular carcinoma (HCC) is a dismal tumor with a high incidence, prevalence, and poor prognosis and survival. Management necessitates multidisciplinary clinics due to the wide heterogeneity in presentation, different therapeutic options, and variable biologic behavior, especially with a background of chronic liver disease. Patients and methods: This study was conducted in a specialized hepatobiliarypancreatic (HBP) clinic in Assiut University Hospital and Sohag University Hospital. We studied different types of patients and tumor characteristics with evaluation of the surgical management applied to them. Further analysis was performed using univariate and multivariate statistics. Results: From December 2000 till March 2014, 220 patients with HCC presented to our clinics; they were predominantly male (mean age 56 years), mostly with cirrhosis due to hepatitis C virus (71%), with Child–Pugh A (52%) or Child−Pugh B (32%), and with a single lesion. Transarterial chemoembolization was the most common treatment (32.4%), followed by ablation therapy (27%). A major section was treated palliatively due to delayed discovery and advanced stage of the disease (63%); resection was the standard in operable cases (25.4%). Nonanatomic resection was commonly performed in 58% of the cases; however, other techniques were also used such as anatomic resection (27%) and laparoscopic resection (15%); unfortunately, the transplantation program was not yet started to be added in treatment. The overall survival was 80% at 6 months, 55% at 1 year, and 20% at 2 years. Serum bilirubin, portal hypertension, the site of the tumor, and the type of treatment were significant independent prognostic factors for survival. Conclusion: Early discovery by surveillance protocols is very essential for better outcome; early interference, whether by surgery or by ablation, is a good substitute in the absence of transplantation programs. Our main prognostic variables are the bilirubin level, portal hypertension, bilobar affection, and the application of specific curative or palliative treatment. Multidisciplinary clinics enhance better HCC management.