Impact of time-to-surgery on outcomes of patients undergoing curative-intent liver resection for BCLC-0, A and B hepatocellular carcinoma. Journal of surgical oncology Tsilimigras, D. I., Hyer, J. M., Diaz, A., Moris, D., Bagante, F., Ratti, F., Marques, H. P., Soubrane, O., Lam, V., Poultsides, G. A., Popescu, I., Alexandrescu, S., Martel, G., Workneh, A., Guglielmi, A., Hugh, T., Aldrighetti, L., Endo, I., Pawlik, T. M. 2020


BACKGROUND: The impact of a prolonged time-to-surgery (TTS) among patients with resectable hepatocellular carcinoma (HCC) is not well defined.METHODS: Patients who underwent curative-intent hepatectomy for BCLC-0, A and B HCC between 2000 and 2017 were identified using a multi-institutional database. The impact of prolonged TTS on overall survival (OS) and disease-free survival (DFS) was examined.RESULTS: Among 775 patients who underwent resection for HCC, 537 (69.3%) had early surgery (TTS<90 days) and 238 (30.7%) patients had a delayed surgery (TTS=90 days). Patient- and tumor-related characteristics were similar between the two groups except for a higher proportion of patients undergoing major liver resection in the early surgery group (31.3% vs. 23.8%, p=.04). The percentage of patients with delayed surgery varied from 8.8% to 59.1% among different centers (p<.001). Patients with TTS<90 days had similar 5-year OS (63.7% vs. 64.9; p=.79) and 5-year DFS (33.5% vs. 42.4; p=.20) with that of patients with TTS=90 days. On multivariable analysis, delayed surgery was not associated with neither worse OS (BCLC-0/A: adjusted hazards ratio [aHR]=0.90; 95% confidence interval [CI]: 0.65-1.25 and BCLC-B: aHR=0.72; 95%CI: 0.30-1.74) nor DFS (BCLC-0/A: aHR=0.78; 95%CI: 0.60-1.01 and BCLC-B: aHR=0.67; 95% CI: 0.36-1.25).CONCLUSION: Approximately one in three patients diagnosed with resectable HCC had a prolonged TTS. Delayed surgery was not associated with worse outcomes among patients with resectable HCC.

View details for DOI 10.1002/jso.26297

View details for PubMedID 33174627