Advertisement

World Journal of Surgery

, Volume 37, Issue 2, pp 452–458 | Cite as

Long-term Outcome after Liver Resection for Hepatocellular Carcinoma Larger than 10 cm

  • Pierre Allemann
  • Nicolas Demartines
  • Hanifah Bouzourene
  • Adrien Tempia
  • Nermin Halkic
Article

Abstract

Background

The purpose of the present study was to analyze long-term survival and disease-free survival after liver resection for giant hepatocellular carcinoma (HCC) ≥ 10 cm compared to HCC < 10 cm in diameter. The surgical approach in the treatment of giant HCC may achieve long-term survival and disease-free survival comparable to treatment of smaller lesions.

Methods

This retrospective analysis was a monocentric study conducted in a tertiary university center. It included 101 patients from 114 consecutive liver resections for HCC, separated into two groups: those with tumors less than 10 cm in diameter (small HCC; n = 79) and those with tumors larger than 10 cm (giant HCC; n = 22). The main outcome measures were overall five-year survival, five-year disease-free survival, recurrence rate, perioperative mortality at 30 days, surgical complication rate, and re-intervention rate.

Results

The two groups were homogeneously distributed, apart from cirrhosis, which was found more frequently in the group with small HCC (77 vs. 41 %; p = 0.0013). Both median survival (24 vs. 27 months; p = 0.0085) and overall 5-year survival (21 vs. 45; p = 0.04) were significantly poorer in the small HCC group compared to the giant HCC group. There were no differences en terms of recurrence rate, pattern, and timing.

Conclusions

Liver resection for HCC larger than 10 cm is a valuable option in selected patients, one that provides overall survival and disease-free survival comparable to smaller lesions. Functional reserves of the liver, more than the size of the lesion, may be important in patient selection for surgical resection.

Keywords

Liver Resection Tace Primary Biliary Cirrhosis Functional Reserve Transcatheter Arterial Chemoembolization 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Mazzaferro V, Regalia E, Doci R et al (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334:693–699PubMedCrossRefGoogle Scholar
  2. 2.
    Llovet JM, Fuster J, Bruix J, Barcelona-Clínic Liver Cancer Group (2004) The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl 10(Suppl 1):S115–S120PubMedCrossRefGoogle Scholar
  3. 3.
    Yeh CN, Chen MF, Lee WC et al (2002) Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis: univariate and multivariate analysis. J Surg Oncol 81:195–202PubMedCrossRefGoogle Scholar
  4. 4.
    Ng KK, Vauthey JN, Pawlik TM, International Cooperative Study Group on Hepatocellular Carcinoma et al (2005) Is hepatic resection for large or multinodular hepatocellular carcinoma justified? Results from a multi-institutional database. Ann Surg Oncol 12:364–373PubMedCrossRefGoogle Scholar
  5. 5.
    Yamashita Y, Taketomi A, Shirabe K et al (2011) Outcomes of hepatic resection for huge hepatocellular carcinoma (≥10 cm in diameter). J Surg Oncol 104:292–298PubMedCrossRefGoogle Scholar
  6. 6.
    Choi GH, Han DH, Kim DH et al (2009) Outcome after curative resection for a huge (≥10 cm) hepatocellular carcinoma and prognostic significance of gross tumor classification. Am J Surg 198:693–701PubMedCrossRefGoogle Scholar
  7. 7.
    Pawlik TM, Delman KA, Vauthey JN et al (2005) Tumor size predicts vascular invasion and histologic grade: implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transpl 11:1086–1092PubMedCrossRefGoogle Scholar
  8. 8.
    Verhoef C, de Man RA, Zondervan PE et al (2004) Good outcomes after resection of large hepatocellular carcinoma in the non-cirrhotic liver. Dig Surg 21:380–386PubMedCrossRefGoogle Scholar
  9. 9.
    Young AL, Malik HZ, Abu-Hilal M et al (2007) Large hepatocellular carcinoma: time to stop preoperative biopsy. J Am Coll Surg 205:453–462PubMedCrossRefGoogle Scholar
  10. 10.
    Ba MC, Cui SZ, Lin SQ et al (2010) Resection of a giant hepatocellular carcinoma weighing over ten kilograms. World J Gastroenterol 16:1422–1424PubMedCrossRefGoogle Scholar
  11. 11.
    Korkolis DP, Aggeli C, Plataniotis GD et al (2009) Successful en bloc resection of primary hepatocellular carcinoma directly invading the stomach and pancreas. World J Gastroenterol 15:1134–1137PubMedCrossRefGoogle Scholar
  12. 12.
    Hironori K, Masaru T, Yuichiro O et al (2008) Laparoscopy-assisted hepatectomy for giant hepatocellular carcinoma. Surg Laparosc Endosc Percutan Tech 18:127–131PubMedCrossRefGoogle Scholar
  13. 13.
    Miyoshi A, Takahashi T, Otsuka T et al (2009) Efficacy of major hepatectomy for large hepatocellular carcinoma. Hepatogastroenterology 56:768–772PubMedGoogle Scholar
  14. 14.
    Yang LY, Fang F, Ou DP et al (2009) Solitary large hepatocellular carcinoma: a specific subtype of hepatocellular carcinoma with good outcome after hepatic resection. Ann Surg 249:118–123PubMedCrossRefGoogle Scholar
  15. 15.
    Pawlik TM, Poon RT, Abdalla EK, International Cooperative Study Group on Hepatocellular Carcinoma et al (2005) Critical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma. Arch Surg 140:450–457PubMedCrossRefGoogle Scholar
  16. 16.
    Chen XP, Qiu FZ, Wu ZD et al (2006) Hepatectomy for huge hepatocellular carcinoma in 634 cases. World J Gastroenterol 12:4652–4655PubMedGoogle Scholar
  17. 17.
    Liau KH, Ruo L, Shia J et al (2005) Outcome of partial hepatectomy for large (>10 cm) hepatocellular carcinoma. Cancer 104:1948–1955PubMedCrossRefGoogle Scholar
  18. 18.
    Shah SA, Wei AC, Cleary SP et al (2007) Prognosis and results after resection of very large (≥10 cm) hepatocellular carcinoma. J Gastrointest Surg 11:589–595PubMedCrossRefGoogle Scholar
  19. 19.
    Wang CC, Jawade K, Yap AQ et al (2010) Resection of large hepatocellular carcinoma using the combination of liver hanging maneuver and anterior approach. World J Surg 34:1874–1878. doi: 10.1007/s00268-010-0546-9 PubMedCrossRefGoogle Scholar
  20. 20.
    Wang J, Xu LB, Liu C et al (2010) Prognostic factors and outcome of 438 Chinese patients with hepatocellular carcinoma underwent partial hepatectomy in a single center. World J Surg 34:2434–2441. doi: 10.1007/s00268-010-0664-4 PubMedCrossRefGoogle Scholar
  21. 21.
    Shimada K, Sakamoto Y, Esaki M et al (2008) Role of a hepatectomy for the treatment of large hepatocellular carcinomas measuring 10 cm or larger in diameter. Langenbecks Arch Surg 93:521–526CrossRefGoogle Scholar
  22. 22.
    Pandey D, Lee KH, Wai CT et al (2007) Long-term outcome and prognostic factors for large hepatocellular carcinoma (10 cm or more) after surgical resection. Ann Surg Oncol 14:2817–2823PubMedCrossRefGoogle Scholar
  23. 23.
    Nagano Y, Tanaka K, Togo S et al (2005) Efficacy of hepatic resection for hepatocellular carcinomas larger than 10 cm. World J Surg 29:66–71. doi: 10.1007/s00268-004-7509-y PubMedCrossRefGoogle Scholar
  24. 24.
    Zhou XD, Tang ZY, Ma ZC et al (2003) Surgery for large primary liver cancer more than 10 cm in diameter. J Cancer Res Clin Oncol 129:543–548PubMedCrossRefGoogle Scholar
  25. 25.
    Mok KT, Wang BW, Lo GH et al (2003) Multimodality management of hepatocellular carcinoma larger than 10 cm. J Am Coll Surg 197:730–738PubMedCrossRefGoogle Scholar
  26. 26.
    Poon RT, Fan ST, Wong J (2002) Selection criteria for hepatic resection in patients with large hepatocellular carcinoma larger than 10 cm in diameter. J Am Coll Surg 194:592–602PubMedCrossRefGoogle Scholar
  27. 27.
    Inagaki H, Ito N, Kurokawa T et al (2004) A case of giant hepatocellular carcinoma treatable with radio frequent ablation therapy after effective UFT administration. Gan To Kagaku Ryoho 31:1411–1414PubMedGoogle Scholar
  28. 28.
    Hirooka M, Koizumi Y, Kisaka Y et al (2010) Mass reduction by radiofrequency ablation before hepatic arterial infusion chemotherapy improved prognosis for patients with huge hepatocellular carcinoma and portal vein thrombus. AJR Am J Roentgenol 194:221–226CrossRefGoogle Scholar
  29. 29.
    Sun WB, Ding XM, Ke S et al (2009) Repeated radiofrequency ablation as both salvage solution and curative treatment for spontaneous rupture of giant medial lobe hepatocellular carcinoma. Chin Med J (Engl) 122:2067–2070Google Scholar
  30. 30.
    Künzli BM, Abitabile P, Maurer CA (2011) Radiofrequency ablation of liver tumors: actual limitations and potential solutions in the future. World J Hepatol 3:8–14PubMedGoogle Scholar
  31. 31.
    Yajima Y, Miyazaki A, Miyasato S et al (1996) A case of giant hepatocellular carcinoma successfully treated by arterial administration of SMANCS. Gan To Kagaku Ryoho 23:1325–1329PubMedGoogle Scholar
  32. 32.
    Harada W, Kitamoto M, Hayashi R et al (2009) Large hepatocellular carcinoma successfully treated with transarterial chemoembolization using cisplatin. Nippon Shokakibyo Gakkai Zasshi 106:1189–1195PubMedGoogle Scholar
  33. 33.
    Huang YH, Wu JC, Chen SC et al (2006) Survival benefit of transcatheter arterial chemoembolization in patients with hepatocellular carcinoma larger than 10 cm in diameter. Aliment Pharmacol Ther 23:129–135PubMedCrossRefGoogle Scholar
  34. 34.
    Zhou WP, Lai EC, Li AJ et al (2009) A prospective, randomized, controlled trial of preoperative transarterial chemoembolization for resectable large hepatocellular carcinoma. Ann Surg 249:195–202PubMedCrossRefGoogle Scholar
  35. 35.
    Uchiyama K, Mori K, Tabuse K et al (2008) Assessment of liver function for successful hepatectomy in patients with hepatocellular carcinoma with impaired hepatic function. J Hepatobiliary Pancreat Surg 15:596–602PubMedCrossRefGoogle Scholar
  36. 36.
    Lau H, Man K, Fan ST et al (1997) Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy. Br J Surg 84:1255–1259PubMedCrossRefGoogle Scholar
  37. 37.
    Ishizawa T, Hasegawa K, Aoki T et al (2008) Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology 134:1908–1916PubMedCrossRefGoogle Scholar
  38. 38.
    Zhou L, Rui JA, Wang SB et al (2011) Prognostic factors of solitary large hepatocellular carcinoma: the importance of differentiation grade. Eur J Surg Oncol 37:521–525PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Pierre Allemann
    • 1
  • Nicolas Demartines
    • 1
  • Hanifah Bouzourene
    • 2
  • Adrien Tempia
    • 1
  • Nermin Halkic
    • 1
  1. 1.Department of Visceral Surgery and TransplantationUniversity Hospital CHUVLausanneSwitzerland
  2. 2.Department of PathologyUniversity Hospital CHUVLausanneSwitzerland

Personalised recommendations