C. C. N. Chong, V. W. S. Wong, P. B. S. Lai and H. L. Y. Chan

Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.

Abstract

Whether patients who have started anti-viral therapy before or after therapy will have the same prognosis remains an unanswered question. Hepatic resection may cause hepatitis B virus (HBV) reactivation and subsequent fulminant hepatitis, liver failure or death.[3] We agree that it is more appropriate to initiate anti-viral therapy before liver resection, as anti-viral therapy has been shown to significantly reduce the rate of HBV reactivation.[4] However, due to logistic reasons, not every patient is able to receive anti-viral therapy before resection. Our results showed that even patients treated after hepatectomy did better than those patients who were never on any anti-viral therapy (P < 0.001) and there was no statistically significant difference in the overall survival of patients who started anti-viral therapy before or after hepatectomy (P = 0.054).[2] Therefore, patients who have not been treated before surgery should still receive anti-viral therapy afterwards. We acknowledge the potential bias in all studies involving historical controls. However, in our study the prospective and retrospective cohorts had similar follow-up time and early and late recurrence rates. While evidence supporting the benefit of anti-viral therapy on post-hepatectomy survival is more consistent, further data is needed to show the impact of anti-viral therapy on late recurrence.