title: Selection criteria for hepatic resection in patients with large hepatocellular carcinoma larger than 10 cm in diameter.
abstract: BACKGROUND
  The role of hepatic resection for large hepatocellular carcinoma (HCC) larger than 10 cm remains unclear.
  
  
  METHODS
  Perioperative and longterm outcomes of 120 patients with HCC larger than 10 cm who underwent resection (group A) were compared with 368 patients with smaller HCC (group B). The prognostic factors in group A were analyzed.
  
  
  RESULTS
  A higher proportion of patients underwent major hepatic resection in group A than in group B (90% versus 57.6%, p = 0.001), but the hospital mortality was similar (5.0% versus 4.6%, p = 0.874). Group A had worse longterm overall survival (median 18.8 months versus 62.8 months, p < 0.001) and disease-free survival (median 5.5 months versus 25.4 months, p < 0.001) than group B. Macroscopic residual tumor, macroscopic venous invasion, and multiple tumors were identified as independent prognostic factors in group A. The median survival of patients with residual tumor and those with curative resection was 7.7 months and 20.8 months, respectively. The median survival of patients with curative resection of solitary HCC larger than 10cm without macroscopic venous invasion was 38.0 months; that of patients with both macroscopic venous invasion and multiple tumors was only 10.5 months.
  
  
  CONCLUSIONS
  Hepatic resection is a safe and effective treatment for HCC larger than 10cm when liver function reserve is satisfactory and when curative resection can be expected. Patients with solitary HCC larger than 10cm without macroscopic venous invasion can enjoy longterm survival after surgery, and we propose hepatic resection as a standard treatment for this group of patients.
authors.affiliation: Centre for the Study of Liver Disease and the Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, China.
authors.forename: Ronnie Tung-Ping
authors.initials: RT
authors.lastname: Poon
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: John
authors.initials: J
authors.lastname: Wong
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D016022:Case-Control Studies; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome