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Journal of Gastrointestinal Surgery

, Volume 11, Issue 5, pp 589–595 | Cite as

Prognosis and Results After Resection of Very Large (≥10 cm) Hepatocellular Carcinoma

  • Shimul A. Shah
  • Alice C. Wei
  • Sean P. Cleary
  • Ilun Yang
  • Ian D. McGilvray
  • Steven Gallinger
  • David R. Grant
  • Paul D. Greig
Article

Abstract

Introduction

Few potentially curative treatment options exist besides resection for patients with very large (≥10 cm) hepatocellular carcinoma (HCC). We sought to examine the outcomes and risk factors for recurrence after resection of ≥10 cm HCC.

Methods

Perioperative and long-term outcomes were examined for 189 consecutive patients from 1993 to 2004 who underwent potentially curative resection of HCC ≥10 cm (n = 24; 13%) vs. those with HCC <10 cm (n = 165; 87%). Disease-free survival (DFS) and overall survival (OS) were determined by Kaplan–Meier analysis and patient, tumor, and treatment characteristics were compared using univariate and multivariate analysis.

Results

Median follow-up was 34 months. Tumors ≥10 cm were more likely to be symptomatic, of poorer grade, and have vascular invasion (p < 0.05). Twelve patients (50%) underwent an extended resection of more than four hepatic segments or resection of adjacent organs for oncologic clearance (diaphragm-2, inferior vena cava (IVC)-2, median sternotomy-1). Postoperative complications were more common after resection of >10 cm HCC (12/24, 50% vs. 35/165, 21%; p = 0.04). Median DFS was significantly shorter in patients with large HCC (≥10 cm) group compared to patients with smaller HCC (8.4 vs. 38 months; p = 0.001), but overall survival was not different between the two groups (5-year survival 54% vs. 53%; p = 0.43). Seventeen patients (71%) with very large HCC developed recurrences (12 intrahepatic, five systemic); eight of these patients (47%) underwent additional therapy (resection-4, TACE-3, RFA-1). Pathological positive margins and vascular invasion were significant determinants of DFS in tumors ≥10 cm (p < 0.05), but only vascular invasion was an independent risk factor for recurrence after multivariate analysis (HR 0.17; 95% CI: 0.04–0.8). Median OS after recurrence was 24 months.

Conclusion

Surgical resection is the optimal therapy for very large (≥10 cm) HCC. Although recurrences are common after resection of these tumors, overall survival was not significantly different from patients after resection of smaller HCC in this series.

Keywords

Hepatocellular carcinoma Resection Vascular invasion Recurrence Ablation Liver transplant 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Shimul A. Shah
    • 1
    • 2
  • Alice C. Wei
    • 1
  • Sean P. Cleary
    • 1
  • Ilun Yang
    • 1
  • Ian D. McGilvray
    • 1
  • Steven Gallinger
    • 1
  • David R. Grant
    • 1
  • Paul D. Greig
    • 1
  1. 1.Department of Surgery, Multi-Organ Transplantation Unit, Toronto General HospitalUniversity Health Network, University of TorontoTorontoCanada
  2. 2.Division of Organ Transplantation, Department of SurgeryUniversity of Massachusetts Memorial Medical Center, University of Massachusetts Medical SchoolWorcesterUSA

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