title: Is hepatic resection for large or multinodular hepatocellular carcinoma justified? Results from a multi-institutional database.
abstract: BACKGROUND
  The role of surgical resection in patients with large or multinodular hepatocellular carcinoma (HCC) remains unclear. This study evaluated the long-term outcome of patients with hepatic resection for large (>5 cm in diameter) or multinodular (more than three nodules) HCC by using a multi-institutional database.
  
  
  METHODS
  The perioperative and long-term outcomes of 404 patients with small HCC (<5 cm in diameter; group 1) were compared with those of 380 patients with large or multinodular HCC (group 2). The prognostic factors in the latter group were analyzed.
  
  
  RESULTS
  The postoperative complication rate (27% vs. 23%; P = .16) and hospital mortality rate (2.4% vs. 2.7%; P = .82) were similar between groups. The overall survival rates were significantly higher in group 1 than group 2 (1 year, 88% vs. 74%; 3 years, 76% vs. 50%; 5 years, 58% vs. 39%; P < .001). Among patients in group 2, five independent prognostic factors were identified to be associated with a worse overall survival: namely, symptomatic disease, presence of cirrhosis, multinodular tumor, microvascular tumor invasion, and positive histological margin.
  
  
  CONCLUSIONS
  Hepatic resection can be safely performed in patients with large or multinodular HCC, with an overall 5-year survival rate of 39%. Symptomatic disease, the presence of cirrhosis, a multinodular tumor, microvascular invasion, and a positive histological margin are independently associated with a less favorable survival outcome.
authors.affiliation: Centre for the Study of Liver Disease, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China.
authors.forename: Kelvin K
authors.initials: KK
authors.lastname: Ng
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Iwao
authors.initials: I
authors.lastname: Ikai
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yamaoka
authors.forename: Steven A
authors.initials: SA
authors.lastname: Curley
authors.forename: David M
authors.initials: DM
authors.lastname: Nagorney
authors.forename: Irene O
authors.initials: IO
authors.lastname: Ng
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Ronnie T
authors.initials: RT
authors.lastname: Poon
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011379:Prognosis; D016019:Survival Analysis