Efficacy of Hepatic Resection for Hepatocellular Carcinomas Larger than 10 cm

Abstract

The objective of this study were to evaluate the efficacy of hepatic resection for large hepatocellular carcinomas (HCCs) and examine clinicopathologic factors influencing overall survival after resection of a large HCC. The pre-, intra-, and postoperative factors and long-term outcome of 26 patients with HCCs >10 cm who underwent hepatic resection (group A) were compared with the those of 143 patients with HCCs < or =10 cm (group B). Hepatic resection for large HCCs can be performed with a mortality rate of 3.8%, which was similar to the rate for group B (2.1%). The overall cumulative survival results for group A (1 year 41.0%, 3 years 29.3%, 5 years 29.3%; median survival 10.1 months) were markedly worse than those for group B (1 year 93.1%, 3 years 74.5%, 5 years 44.7%; median survival 53.4 months) (p < 0.0001). Multivariate analysis identified venous invasion as an independent risk factor of survival of patients with a large HCC. The overall cumulative survival results in patients with venous invasion (1 year 28.0%, 3 years 0%; median survival 6.4 months) were markedly worse than in patients without venous invasion (1 year 64.8%, 3.5 years 64.8%; median survival, 51.8 months) (p < 0.0066). We concluded that hepatic resection can be performed safely for HCCs >10 cm with a low mortality rate. It appears reasonable to believe that hepatic resection is the treatment of choice for large HCCs without venous invasion.

Role of a hepatectomy for the treatment of large hepatocellular carcinomas measuring 10 cm or larger in diameter

“…The reason for the poor survival is due to the high incidence of portal vein tumor thrombus, multiple tumors, and/or non-curative hepatectomies [5][6][7][8][9]. In the current study, a hepatectomy for a solitary large HCC without a macroscopic tumor thrombus could provide excellent surgical outcomes.…”

“…A hepatectomy for large HCCs (≥10.0 cm) remains a challenging surgical procedure because several series have reported where the 5-year survival rate ranged from 16.7 to 32.2% in patients with large HCCs, which were worse in comparison to those with small HCCs [5][6][7][8][9]. The reason for the poor survival is due to the high incidence of portal vein tumor thrombus, multiple tumors, and/or non-curative hepatectomies [5][6][7][8][9].…”

“…Several studies [5][6][7][8][9] have reported that a hepatectomy for large HCCs has been performed with acceptable morbidity and mortality, while also providing a comparable postoperative outcome as in patients with small HCCs, when curative hepatectomies were feasible. However, a hepatectomy has been applied as a procedure for tumor reduction in association with multidisciplinary treatments using local ablation therapy or TACE for lack of effective therapeutic alternatives in HCC patients with advanced tumor spreading [5,10].…”

Predictors of Microvascular Invasion in Hepatocellular Carcinoma

“…The SNEG type and CMN type were reported to have MVI more frequently compared to the SN type, and therefore they are called ‘invasive gross types' [6,8,10,11,12]. Even in patients with HCC ≥10 cm, the invasive gross type is the poorest prognostic factor after hepatic resection [6,7], and in patients with HCC ≤2 cm, invasive gross type is the greatest risk factor for MVI [8]. Therefore, the correct diagnosis of the gross type by imaging analysis is important irrespective of the tumor size.…”

“…With the current advanced imaging modalities, however, MVI to peripheral portal or hepatic venous areas is difficult to detect, and therefore, the tumor size of HCC is considered the most reliable predictive factor for MVI [1,5]. In recent reports, however, patients with HCC ≥10 cm in diameter without MVI had a good prognoses similar to those of patients with HCC <5 cm in diameter without MVI after hepatic resection [6,7]. These reports indicate that the tumor size alone thus could not predict the grade of HCC malignancy.…”