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Hepatectomy for Huge Hepatocellular Carcinoma: Single Institute’s Experience

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Abstract

Background

The surgical resection of huge hepatocellular carcinoma (HCC) is still controversial. This study was designed to introduce our experience of liver resection for huge HCC and evaluate the safety and outcomes of hepatectomy for huge HCC.

Methods

A total of 258 hepatic resections for the patients with huge HCC were analysed retrospectively from December 2002 to December 2011. The operative outcomes were compared with 293 patients with HCC >5.0 cm but <10.0 cm in diameter. Prognostic factors for long-term survival were evaluated by univariate and multivariate analyses.

Results

The 1-, 3-, 5-year overall survival rates after liver resection were 84, 62, and 33 %. Overall survival and disease-free survival in huge HCC group and HCC >5.0 cm but <10.0 cm group were similar (P = 0.751, P = 0.493). Solitary huge HCC group has significantly a more longer overall and disease-free survival time than nodular huge HCC (P = 0.026, P = 0.022). Univariate and multivariate analysis revealed that the types of tumour, vascular invasion, and UICC stage were independent prognostic factors for overall survival (P = 0.047, P = 0.037, P = 0.033).

Conclusions

Hepatic resection can be performed safely for huge HCC with a low mortality and favorable survival outcomes. Solitary huge HCC has the better surgical outcomes than nodular huge HCC.

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Acknowledgment

Supported by National High Technology Research and Development Program of China (2006AA02Z4B2), National Science and Technology Major Projects (2009ZX09103-681), Clinical Subjects’ Key Project of Ministry of Health (2007–2009), and National Natural Science Foundation of China (81172018).

Conflict of interest

The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Liver Cancer Laboratory, Department of Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China

    Lianyue Yang, Jiangfeng Xu, Dipeng Ou, Wei Wu & Zhijun Zeng

Authors
  1. Lianyue Yang
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  2. Jiangfeng Xu
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  3. Dipeng Ou
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  4. Wei Wu
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  5. Zhijun Zeng
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Corresponding author

Correspondence to Lianyue Yang.

Electronic supplementary material

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268_2013_2095_MOESM1_ESM.tif

Supplementary-Figure 1. Computed tomography scan and human HCC tumor specimens from hepatectomy. (A-C) show solitary huge HCC, 19.0 × 15.0 cm, expansive growth within an intact capsule. (D-F) show nodular huge HCC, 12.0 × 8.0 cm, multiple nodules, without capsules. (TIFF 1402 kb)

268_2013_2095_MOESM2_ESM.tif

Supplementary-Figure 2. (A) Liver parenchyma was transected using a combining techniques with a straight iron suction and the high frequency electrical knife. After selective hemihepatic inflow occlusion, incision was made along the liver-cutting line, using the scraping, suction, stir, coagulation, ligation technology. (B) To dissect and ligate the right anterior branche of the portal trunk. (C) The remnant liver was sutured by mattres apposition suture. (D) A solitary huge HCC was removed, tumor size 12.0 ×9.0 cm. (TIFF 1683 kb)

268_2013_2095_MOESM3_ESM.tif

Supplementary-Figure 3. Anterior resection for left hemihepatectomy: liver hanging maneuver combined with selective hemihepatic inflow occlusion. (A) CT scan demonstrated a nodular HCC in left lobe with thrombus, tumor size 13.0 × 8.0 cm. (B) Selective hemihepatic inflow occlusion, the white arrow to the left portal pedicle occlusion belt. The blue arrow to the right portal pedicle occusion belt and yellow one to Pringle manuver occlusion belt. (C) liver hanging maneuver: to establish retrohepatic inferior retrohepaticvena cava tunnel. The arrow show that the vascular clamp had pass through the tunnel and reached the suprahepatic vena cava lacunae. (D) Two liver hanging belts were placed through the tunnel. Ischemia boundary which indicate the cutting-line appeared after left portal pedicle occlusion. The white arrows show the liver hanging belts. The yellow arrow show the ischemia boundary (TIFF 843 kb)

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Yang, L., Xu, J., Ou, D. et al. Hepatectomy for Huge Hepatocellular Carcinoma: Single Institute’s Experience. World J Surg 37, 2189–2196 (2013). https://doi.org/10.1007/s00268-013-2095-5

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  • DOI: https://doi.org/10.1007/s00268-013-2095-5

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