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Is Hepatectomy for Huge Hepatocellular Carcinoma (≥10cm in Diameter) Safe and Effective? A Single-center Experience

  • Yang, Jian (Department of Liver Surgery and Liver Transplantation, West China Hospital, Sichuan University) ;
  • Li, Chuan (Department of Liver Surgery and Liver Transplantation, West China Hospital, Sichuan University) ;
  • Wen, Tian-Fu (Department of Liver Surgery and Liver Transplantation, West China Hospital, Sichuan University) ;
  • Yan, Lu-Nan (Department of Liver Surgery and Liver Transplantation, West China Hospital, Sichuan University) ;
  • Li, Bo (Department of Liver Surgery and Liver Transplantation, West China Hospital, Sichuan University) ;
  • Wang, Wen-Tao (Department of Liver Surgery and Liver Transplantation, West China Hospital, Sichuan University) ;
  • Yang, Jia-Yin (Department of Liver Surgery and Liver Transplantation, West China Hospital, Sichuan University) ;
  • Xu, Ming-Qing (Department of Liver Surgery and Liver Transplantation, West China Hospital, Sichuan University)
  • Published : 2014.09.15

Abstract

Background: This retrospective study aimed to validate the safety and effectiveness of hepatectomy for huge hepatocellular carcinoma (HCC). Materials and Methods: Data of patients who underwent hepatectomy for HCC between January 2006 and December 2012 were reviewed. The patients were divided into three groups: huge HCC(${\geq}10cm$ in diameter), large HCC(${\geq}5$ but<10 cm in diameter) and small HCC(<5cm in diameter). Results: Characteristics of pre-operative patients in all three groups were homogeneously distributed except for alpha fetal protein (AFP)(p<0.001).The 30, 60, 90-day post-operative mortality rates were not different among the three groups (p=0.785, p=0.560, and p=0.549). Laboratory data at 1, 3, and 7 days after surgery also did not vary. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) rates in the huge and large HCC groups were lower than that of the small HCC group (OS: 32.5% vs 36.3% vs 71.2%, p=0.000; DFS: 20.0% vs 24.8% vs 40.7%, p=0.039), but there was no difference between the huge and large HCC groups (OS: 32.5% vs 36.3%, p=0.667; DFS: 20.0% vs 24.8%, p=0.540). In multivariate analysis, five independent poor prognostic factors that affected OS were significantly associated with worse survival (p<0.05), namely, AFP level, macrovascular invasion, Edmondsone Steiner grade, surgical margin and Ishak score. AFP level, macrovascular invasion, microvascular invasion, and surgical margin influenced disease-free survival independently (p<0.05). Conclusions: The safety of hepatectomy for huge HCC is similar to that for large and small HCC; and this approach for huge HCC may achieve similar long-term survival and disease-free survival as for large HCC.

Keywords

Hepatocellular carcinoma;hepatectomy;safety;effectiveness;short-term results;long-term results

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