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Long Term Outcome and Prognostic Factors for Large Hepatocellular Carcinoma (10 cm or more) after Surgical Resection

  • Hepatic and Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Surgical resection is the standard treatment for hepatocellular carcinoma (HCC). However, the role of surgery in treatment of large tumors (10 cm or more) is controversial. We have analyzed, in a single centre, the long-term outcome associated with surgical resection in patients with such large tumors.

Methods

We retrospectively investigated 166 patients who had undergone surgical resection between July 1995 and December 2006 because of large (10 cm or more) HCC. Survival analysis was done using the Kaplan-Meier method. Prognostic factors were evaluated using univariate and multivariate analyses.

Results

Of the 166 patients evaluated, 80% were associated with viral hepatitis and 48.2% had cirrhosis. The majority of patients underwent a major hepatectomy (48.2% had four or more segments resected and 9% had additional organ resection). The postoperative mortality was 3%. The median survival in our study was 20 months, with an actuarial 5-year and 10-year overall survival of 28.6% and 25.6%, respectively. Of these patients, 60% had additional treatment in the form of transarterial chemoembolization, radiofrequency ablation or both. On multivariate analysis, vascular invasion (P < 0.001), cirrhosis (P = 0.028), and satellite lesions/multicentricity (P = 0.006) were significant prognostic factors influencing survival. The patients who had none of these three risk factors had 5-year and 10-year overall survivals of 57.7% each, compared with 22.5% and 19.3%, respectively, for those with at least one risk factor (P < 0.001).

Conclusions

Surgical resection for those with large HCC can be safely performed with a reasonable long-term survival. For tumors with poor prognostic factors, there is a pressing need for effective adjuvant therapy.

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Acknowledgement

We gratefully acknowledge Ms. Pamela Jenkin’s contribution in the data collection.

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Authors and Affiliations

  1. Hepatobiliary Surgery and Liver Transplantation, Asian Centre for Liver Diseases and Transplantation, Singapore, Singapore

    Durgatosh Pandey MS, DNB, M.Ch, Gajanan Wagholikar MS, M.Ch & Kai-Chah Tan FRCS

  2. Respiratory Medicine & Critical Care, Asian Centre for Liver Diseases and Transplantation, Singapore, Singapore

    Kang-Hoe Lee MRCP

  3. Hepatology, Asian Centre for Liver Diseases and Transplantation, Singapore, Singapore

    Chun-Tao Wai MRCP

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  1. Durgatosh Pandey MS, DNB, M.Ch
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  2. Kang-Hoe Lee MRCP
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  3. Chun-Tao Wai MRCP
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Correspondence to Durgatosh Pandey MS, DNB, M.Ch.

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Pandey, D., Lee, KH., Wai, CT. et al. Long Term Outcome and Prognostic Factors for Large Hepatocellular Carcinoma (10 cm or more) after Surgical Resection. Ann Surg Oncol 14, 2817–2823 (2007). https://doi.org/10.1245/s10434-007-9518-1

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