title: Outcome of partial hepatectomy for large (> 10 cm) hepatocellular carcinoma.
abstract: BACKGROUND
  Surgical resection for large (> 10 cm) hepatocellular carcinoma (HCC) is believed by many to be ineffective. The objective of the current study was to review the outcome of partial hepatectomy in patients with large HCC.
  
  
  METHODS
  Between 1985 and 2002, 193 consecutive patients who underwent partial hepatectomy for HCC were identified from a prospective database. The 82 patients with tumors > 10 cm were compared with the remaining 111 patients with < or = 10 cm tumors. Clinicopathologic features were analyzed and prognostic factors were evaluated by univariate and multivariate analysis.
  
  
  RESULTS
  The 5-year overall survival for patients with large HCC was 33% with a median of 32 months. Patients with < or = 10 cm tumors had similar survival. Furthermore, there was no significant difference between the groups in operative mortality (2% in large HCC vs. 6%) or recurrence rate. In patients with large HCC, vascular invasion by tumor and intraoperative blood loss > 2 liters predicted overall survival on multivariate analysis.
  
  
  CONCLUSIONS
  Partial hepatectomy is safe for patients with large HCC. In selected patients with large tumors, resection achieves similar overall survival and recurrence-free survival to that of patients with smaller tumors. Minimizing intraoperative blood loss appears to be critical for favorable long-term outcome in patients with large HCC.
authors.affiliation: Hepatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: Kui-Hin
authors.initials: KH
authors.lastname: Liau
authors.forename: Leyo
authors.initials: L
authors.lastname: Ruo
authors.forename: Jinru
authors.initials: J
authors.lastname: Shia
authors.forename: Aasim
authors.initials: A
authors.lastname: Padela
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.forename: Michael I
authors.initials: MI
authors.lastname: D'Angelica
authors.forename: Leslie H
authors.initials: LH
authors.lastname: Blumgart
authors.forename: Ronald P
authors.initials: RP
authors.lastname: DeMatteo
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden