• hepatocellular carcinoma;
  • primary liver tumour;
  • hepatectomy;
  • liver resection;
  • survival;
  • systematic review


Background:  Hepatic resection is a potentially curative therapy for hepatocellular carcinoma (HCC), but recurrence of disease is very common. Few studies have reported 10-year actual survival rates following hepatic resection; instead, most have used actuarial measures based on the Kaplan–Meier method. This systematic review aims to document 10-year actual survival rates and to identify factors significant in determining prognosis.

Methods:  A comprehensive search was undertaken of MEDLINE and EMBASE. Only studies reporting the absolute number of patients alive at 10 years after first resection for HCC were included; these figures were used to calculate the actual 10-year survival rate. A qualitative review and analysis of the prognostic factors identified in the included studies were performed.

Results:  Fourteen studies, all of which were retrospective case series, including data on 4197 patients with HCC were analysed. Ten years following resection, 303 of these patients were alive. The 10-year actual survival rate was 7.2%, whereas the actuarial survival quoted from the same studies was 26.8%. Positive prognostic factors included better hepatic function, a wider surgical margin and the absence of satellite lesions.

Conclusions:  The actual long-term survival rate after resection of HCC is significantly inferior to reported actuarial survival rates. The Kaplan–Meier method of actuarial survival analysis tends to overestimate survival outcomes as a result of censorship of data and subgroup analysis.