title: Surgical treatment and outcome in patients with a hepatocellular carcinoma greater than 10 cm in diameter.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) over 10 cm in diameter at the time of diagnosis continues to account for a number of patients undergoing hepatic resection. This study evaluated the clinicopathological features and outcome following surgery for large HCC.
  
  
  METHODS
  Forty patients with a large HCC (greater than 10 cm) (group 1) resected between 1991 and 1996 were studied retrospectively. They were compared with 245 patients who had smaller HCCs (10 cm or less) (group 2).
  
  
  RESULTS
  No patient in group 1 had hepatitis C infection compared with 22.9 per cent in group 2 (P=0.001). Patients in group 1 were significantly younger, had higher alpha-fetoprotein levels (16750 versus 1864 ng/ml; P < 0.001), better liver function, a higher incidence of multiple tumours (27 of 40 versus 42.0 per cent; P=0.003) and venous invasion (35 of 40 versus 52.2 per cent; P < 0.001), and underwent more major resections (37 of 40 versus 26.5 per cent; P < 0.001) than those in group 2. Morbidity and mortality rates and hospital stay were comparable in the two groups. For group 1, the 1-, 3- and 5-year disease-free survival rates were 42, 30 and 28 per cent respectively. Multiple tumours, venous invasion and impaired liver function were factors associated with recurrence.
  
  
  CONCLUSIONS
  Large HCC had specific clinicopathological features. In selected patients, resection is safe and offers the chance of long-term disease-free survival.
authors.affiliation: Department of Surgery, Veterans General Hospital Taipei and College of Medicine, National Yang-Ming University, Taiwan.
authors.forename: N H
authors.initials: NH
authors.lastname: Lee
authors.forename: G Y
authors.initials: GY
authors.lastname: Chau
authors.forename: W Y
authors.initials: WY
authors.lastname: Lui
authors.forename: K L
authors.initials: KL
authors.lastname: King
authors.forename: S H
authors.initials: SH
authors.lastname: Tsay
authors.forename: C W
authors.initials: CW
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome