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.
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