Significant Improvement in Long-Term Survival after Liver Resection for Hepatocellular Carcinoma: Evolving Outcomes over 20 Years

Abstract

Purpose: Advanced techniques and multidisciplinary approaches have improved hepatocellular carcinoma (HCC) surgical outcomes. This study updates the long-term survival after liver resection (LR) for HCC based on over 20 years of experience.

Materials and methods: Between 1996 and 2017, 1963 patients with HCC underwent LR. After excluding 185 patients who received preoperative therapy, 1778 treatment-naïve HCC patients were included. Clinicopathological characteristics and surgical outcomes were compared across three periods: 1 (1996-2007), 2 (2008-2012), and 3 (2013-2017). Prognostic factors for overall survival (OS) and disease-free survival (DFS) were analyzed using Cox regression analysis.

Results: Recent trends indicate increased diagnoses at older ages, number of non-B and non-C HCC cases and decreased incidence of cirrhosis. Minor, non-anatomical, and minimally invasive LR have become more prevalent. In period 3, short-term outcomes improved, as 90-day mortality decreased to 0.3% and major complications to 5.0%. Long-term outcomes improved (5-year OS: 68.1% vs. 80.7% vs. 90.5%, p<0.001; 5-year DFS: 41.4% vs. 50.7% vs. 61.1%, p<0.001), and early recurrence rates decreased in period 3 (34.0% vs. 34.0% vs. 25.8%, p<0.001). Factors such as smaller tumor size, decreased incidence of cirrhosis, fewer intraoperative transfusions, and fewer major complications have contributed to improved OS and DFS.

Conclusion: Remarkable improvements in 5-year OS and DFS were observed after curative LR for HCC, particularly in period 3. Advancements in surgical outcomes, including very low short-term mortality, along with improved surgical techniques, early detection, and refined patient selection, are likely key factors in this progress.

Keywords: Hepatocellular carcinoma; liver resection; long-term outcomes.