Surgical Management and Outcomes of Hepatocellular Carcinoma at a Tertiary Hospital in Enugu State

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy in Nigeria, predominantly arising in the context of chronic hepatitis B infection and liver cirrhosis. Early-stage HCC is potentially curable through surgical resection, yet the vast majority of Nigerian patients present with advanced, unresectable disease. This study evaluates the surgical management and outcomes of HCC patients at a tertiary institution in Enugu State, South East Nigeria, from 2019 to 2023. A retrospective review of 60 histologically confirmed HCC cases was conducted. Variables analyzed included Child-Pugh liver function class, tumour size and multifocality, AFP levels, surgical resectability, type of hepatic resection performed, postoperative complications, and 12-month survival. Only 22% of patients were deemed surgically resectable at presentation. Partial hepatectomy was performed in 13 patients, with postoperative liver failure in two cases and wound infection in four. Twelve-month survival in the resected group was 69% versus 11% in unresected patients. Hepatitis B vaccination status was unknown in 72% of patients. The study recommends national hepatitis B vaccination scale-up, targeted HCC surveillance programs for cirrhotic patients, and development of hepatobiliary surgical expertise at South East tertiary centers to improve resection rates and outcomes. Keywords: hepatocellular carcinoma, liver resection, hepatitis B, Enugu, oncological surgery