Abstract
While hepatocellular carcinoma (HCC) is one of the world’s most common malignant neoplasms, with its highest prevalence in southeast Asia and portions of Africa, it remains a relatively rare malignancy in the western world. The incidence of concomitant cirrhosis is significantly higher in Asia, being over 70% [1–5] compared to less than 40% in western countries [6,7]. The overall 5-year survival after resection with curative intent in the West approaches 35–45% [8–10], whereas it ranges from 15% to 30% in the East [1, 2, 11, 12]. Recent implementation of mass screening programs using alphafeto protein and ultrasound in high-risk populations in Japan and China have identified increasing numbers of patients with small (<5cm) HCC. Several reports from Asia have shown improved survival after limited resection for small HCC [4, 13]. However, this improved survival has not been observed uniformly [5]. Although there are significant regional differences in epidemiology, clinicopathologic characteristics, and treatment results of HCC between the East and West, both the eastern and western literature have shown that the single treatment modality that prolongs survival in patients with HCC is surgical resection. The western HCC registry is a multiinstitutional effort aimed at analyzing the patterns of disease, prognostic factors, and postresectional survival of HCC in the western world.