title: Hepatic resection for large hepatocellular carcinoma.
abstract: BACKGROUND
  Long-term survival and prognostic factors after hepatic resection for large hepatocellular carcinoma (HCC) remain to be proved.
  
  
  METHODS
  The surgical outcome in 133 consecutive patients with HCC in diameter of > or = 5 cm (large HCC; L group) undergoing hepatic resection was retrospectively clarified and compared with that of 253 patients with HCC in diameter of < 5 cm (small HCC; S group). Postresection prognostic factors were evaluated by univariate and multivariate analysis using Cox's proportional hazards model.
  
  
  RESULTS
  The disease-free 3- and 5-year survival rates between L group and S group were 26% versus 42% and 20% versus 25%, respectively (P = 0.0032). The overall 3- and 5-year survival rates between L group and S group were 38% versus 67% and 28% versus 47%, respectively (P < 0.0001). Multivariate analysis revealed that large amount of intraoperative blood transfusion was an independently significant factor of poor disease-free and overall survivals.
  
  
  CONCLUSIONS
  Long-term survival in patients with large HCC remains unsatisfactory compared with that in patients with non-large HCC. Restriction of intraoperative blood transfusion may play an important role in the improvement of survival and recurrence in such patients.
authors: Second Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan. hanayan@hsp.md.shinshu-u.ac.jp
authors: K
authors: K
authors: Hanazaki
authors: S
authors: S
authors: Kajikawa
authors: N
authors: N
authors: Shimozawa
authors: K
authors: K
authors: Shimada
authors: M
authors: M
authors: Hiraguri
authors: N
authors: N
authors: Koide
authors: W
authors: W
authors: Adachi
authors: J
authors: J
authors: Amano
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate