Single centre experience of liver resection for hepatocellular carcinoma in patients outside transplant criteria

Introduction To report analysis of our results of liver resection for HCC outside the transplant criteria with preserved liver function. Methods Between January 1990 and March 2005, 279 patients with HCC were seen at our institution and entered into a prospective database. There were 51 patients who did not fulfill the transplant criteria and underwent partial hepatectomy. Survival was determined by Kaplan–Meier analysis. Results The median tumour size was 10.0 cm with a range of 3–20 cm. Twenty-nine patients had solitary tumours and 21 patients had two or more liver tumours, with four patients whose tumours were less than 5 cm in maximal diameter. Ten patients had bilobar disease. The 30-day mortality was 8%. The 1-, 3- and 5-year overall survival was 63, 40 and 33%, respectively, and the median survival was 16.6 months. Fifteen potential variables were analysed as potential predictors of adverse outcome. Multivariate analysis showed Child–Pugh classification, presence of cirrhosis, rupture on presentation and tumour histology to be independent prognostic factors on survival. Conclusion Partial hepatectomy in patients with advanced HCC who are ineligible for transplantation can be performed safely and can achieve a 5-year survival of 33%.