Which virus is most commonly associated with the need for a liver resection?

From the Guidelines

Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are the most common viruses associated with the need for a liver resection, with HBV being a major risk factor for hepatocellular carcinoma (HCC) in many parts of the world, while HCV is the leading etiology for HCC in North America and other Western countries. These viruses cause chronic hepatitis that can progress to cirrhosis and HCC, which is the primary reason liver resection becomes necessary. According to 1, an estimated 78% of HCC cases and 57% of cases of liver cirrhosis are caused by chronic infection with HBV or HCV. Chronic HBV infection is associated with a 15% to 25% risk of premature death from liver cancer or end-stage liver disease, and approximately 600,000 people die worldwide from HBV-related liver disease or HCC each year.

The selection of patients for surgical resection is based on several criteria, including the absence of extrahepatic disease, the degree of hepatic dysfunction, and technical considerations such as the adequacy of the future liver remnant and tumor involvement of major vascular structures. As noted in 1, patients with normal liver parenchyma are usually eligible for extensive resection, whereas patients with compensated cirrhosis may be candidates for minor or major partial hepatectomy only in selected cases.

Key considerations for managing patients with HBV or HCV who require liver resection include:

• Antiviral therapy to suppress viral replication and improve liver function
• Regular surveillance with ultrasound and alpha-fetoprotein testing to detect HCC at an early, resectable stage
• Evaluation of the severity of liver disease and the potential for liver transplantation
• Technical considerations for surgical resection, including the adequacy of the future liver remnant and tumor involvement of major vascular structures.

Overall, the management of patients with HBV or HCV who require liver resection requires a multidisciplinary approach that takes into account the underlying viral infection, the severity of liver disease, and the technical considerations for surgical resection.

From the Research

Liver Resection and Associated Viruses

• The virus most commonly associated with the need for a liver resection is the Hepatitis B virus (HBV) 2.
• HBV infection is estimated to cause 55%-60% of the cases of hepatocellular carcinoma (HCC) worldwide and over 70% in Asian countries 2.
• Liver resection is currently the mainstay of treatment for HCC due to the low surgical mortality, a wider treatment indication, and simplicity of post-treatment follow-up 2.

Comparison of Antiviral Therapies

• Studies have compared the efficacy of different antiviral therapies, such as tenofovir (TDF) and entecavir (ETV), in patients with HBV-related HCC after liver resection 3, 4, 5.
• TDF therapy has been associated with better recurrence-free survival and overall survival rates compared to ETV therapy in some studies 3, 5.
• However, other studies have found no significant difference in recurrence-free survival between TDF and ETV therapy 4.

Other Viruses Associated with Liver Disease

• Hepatitis C virus (HCV) is also a hepatotropic RNA virus that can cause progressive liver damage, liver cirrhosis, and hepatocellular carcinoma 6.
• However, the studies provided do not specifically address the association between HCV and the need for liver resection.