Comparative analysis of the immediate results of surgical treatment in patients with early (BCLC A) and intermediate (BCLC B) stage hepatocellular carcinoma

Introduction. The intermediate stage (Barcelona Clinic Liver Cancer, stage B, BCLC B) of hepatocellular carcinoma (HCC) is relevant for study in terms of existing problems associated with the treatment of patients with this type of pathology. The BCLC B subgroup comprises approximately 30 % of patients at the time of diagnosis of HCC. However, liver resection may be a more effective treatment option in a selected group of patients with intermediate stage disease that is not included in current BCLC guidelines.Aim. Aim of the study is a comparative assessment of the frequency of postoperative complications and mortality in surgical treatment of patients with HCC BCLC A and BCLC B, analysis of risk factors for the development of severe postoperative complications.Materials and methods. The retrospective analysis included patients who underwent surgery for BCLC A and BCLC B stages of HCC at the N. N. Blokhin National Medical Research Center of Oncology in the period from 2000 to 2022. The main clinical and laboratory data, intraoperative parameters, severity of postoperative complications according to Clavien– Dindo that arose within 30 days after surgery, postoperative mortality, and factors influencing the risk of developing severe postoperative complications were analyzed.Results. The BCLC A group included 120 patients, the BCLC B group included 110 patients. Six (5.5 %) patients in the BCLC B group had Сhild – Pugh В cirrhosis, and none in BCLC A group. Model for end-stage liver disease index 10–19 was more often observed in the BCLC B group than in BCLC A group (20 (18.2 %) vs 8 (6.7 %), р = 0.009), more patients had bilobar involvement (38 (34.5 %) vs 11 (9.2 %), р 0.0001). There were no other significant differences between groups. The median duration of surgery was 160 (60–360) min and 200 (70–360) min in BCLC A and BCLC B groups (p = 0.001), the median blood loss was 700 (10–8000) ml and 1000 (5–7500) ml (p = 0.152), postoperative mortality was 3 (2.5 %) and 3 (2.7 %), respectively (p 0.99). There were also no statistically significant differences in the total number of early postoperative complications: 46 (38.3 %) in the BCLC B group and 22 (29.1 %) in the BCLC A group, p = 0.164. When conducting a multivariate analysis, only the presence of portal hypertension (hazard ratio 10.596, 95 % confidence interval 3.351–33.500, p 0.0001) was associated with an increased risk of postoperative complications, while when performing sparing liver resection, a decrease was noted (hazard ratio 0.157, 95 % confidence interval 0.040–0.617, p = 0.008).Conclusion. During the comparative group analysis, the incidence of postoperative complications and mortality did not differ statistically significantly, which may indicate the safety of surgical treatment in the BCLC B group of patients and indicate the possibility of liver resection in the selected group of patients.