Surgical outcome of open liver resection for HCC: a multi- centre prospective study, an experience from low income country

Abstract

Hepatocellular carcinoma (HCC) is a leading cause of global cancer mortality and health system burden. In low- and middle-income countries (LMICs), preventable risk factors, late presentation, and limited access to curative surgery contribute to poor survival. These disparities highlight HCC as one of the most inequitable conditions in global cancer care. To assess the clinical profile, major risk factors, and perioperative outcomes of patients with hepatocellular carcinoma (HCC) treated in multicentre, high-volume surgical centres in Ethiopia in 2026. We conducted a multicentre, prospective observational cohort study to investigate the clinical profile, risk factors, and perioperative outcomes of hepatocellular carcinoma (HCC). A total of 101 patients with HCC were enrolled. Normality of continuous variables was assessed using the Shapiro–Wilk test. Normally distributed data were summarised means with standard deviations, whereas skewed data were reported as medians with interquartile ranges. Univariable and multivariable binary logistic regression analyses were performed to identify independent predictors of 30-day postoperative complications. Results were presented as adjusted odds ratios (ORs) with 95% confidence intervals, and statistical significance was defined as p<0·05. We analysed 101 patients with hepatocellular carcinoma (HCC) undergoing hepatectomy. The mean age was 57·4 years (SD 14·1), with balanced sex distribution; comorbidities were present in 43·6%. Most patients were ASA II (61·4%) and ECOG 0 (80.2%). Risk factors were identified in 55·4%, predominantly HBV (27·7%), HCV (14·9%), and alcohol use (16·8%). Cirrhosis or fibrosis was present in 50·5%. Single lesions predominated (81·2%), with mean tumour size 6·7 cm (SD 2·5). Minor resections comprised 64·4%. Postoperative complications occurred in 29·7% and mortality rate was 4% within 30-day. The 30-day postoperative complication associated with ASA III (AOR 17·2, 95% CI 1·7–173·7), hypoalbuminemia (AOR 4·9, 95% CI 1·4–17·9), cirrhosis (AOR 5·7, 95% CI 1·4–23·4), and major resection (AOR 5·6, 95% CI 1·3–23·9). Despite patients presenting with younger age, low ASA and ECOG scores, and predominantly early Barcelona stage, perioperative morbidity and mortality remained high. These findings underscore persistent inequities in hepatocellular carcinoma (HCC) care within low- and middle-income countries, where access to timely diagnosis, surgical expertise, and comprehensive perioperative support remains limited. Addressing these disparities is essential to improve survival outcomes and reduce the global burden of HCC. Not applicable.

The authors' abstract, as published at the source. BMC Surgery, 2026 · DOI ↗