title: Prognosis and results after resection of very large (>or=10 cm) hepatocellular carcinoma.
abstract: BACKGROUND
  Few potentially curative treatment options exist besides resection for patients with very large (>or=10 cm) hepatocellular carcinoma (HCC). We sought to examine the outcomes and risk factors for recurrence after resection of >or=10 cm HCC.
  
  
  METHODS
  Perioperative and long-term outcomes were examined for 189 consecutive patients from 1993 to 2004 who underwent potentially curative resection of HCC >or=10 cm (n = 24; 13%) vs. those with HCC <10 cm (n = 165; 87%). Disease-free survival (DFS) and overall survival (OS) were determined by Kaplan-Meier analysis and patient, tumor, and treatment characteristics were compared using univariate and multivariate analysis.
  
  
  RESULTS
  Median follow-up was 34 months. Tumors >or=10 cm were more likely to be symptomatic, of poorer grade, and have vascular invasion (p < 0.05). Twelve patients (50%) underwent an extended resection of more than four hepatic segments or resection of adjacent organs for oncologic clearance (diaphragm-2, inferior vena cava (IVC)-2, median sternotomy-1). Postoperative complications were more common after resection of >10 cm HCC (12/24, 50% vs. 35/165, 21%; p = 0.04). Median DFS was significantly shorter in patients with large HCC (>or=10 cm) group compared to patients with smaller HCC (8.4 vs. 38 months; p = 0.001), but overall survival was not different between the two groups (5-year survival 54% vs. 53%; p = 0.43). Seventeen patients (71%) with very large HCC developed recurrences (12 intrahepatic, five systemic); eight of these patients (47%) underwent additional therapy (resection-4, TACE-3, RFA-1). Pathological positive margins and vascular invasion were significant determinants of DFS in tumors >or=10 cm (p < 0.05), but only vascular invasion was an independent risk factor for recurrence after multivariate analysis (HR 0.17; 95% CI: 0.04-0.8). Median OS after recurrence was 24 months.
  
  
  CONCLUSIONS
  Surgical resection is the optimal therapy for very large (>or=10 cm) HCC. Although recurrences are common after resection of these tumors, overall survival was not significantly different from patients after resection of smaller HCC in this series.
authors: Department of Surgery, Multi-Organ Transplantation Unit, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada. shahs01@ummhc.org
authors: Shimul A
authors: SA
authors: Shah
authors: Alice C
authors: AC
authors: Wei
authors: Sean P
authors: SP
authors: Cleary
authors: Ilun
authors: I
authors: Yang
authors: Ian D
authors: ID
authors: McGilvray
authors: Steven
authors: S
authors: Gallinger
authors: David R
authors: DR
authors: Grant
authors: Paul D
authors: PD
authors: Greig
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D003964:Diaphragm / Q000601:surgery; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013249:Sternum / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000556:secondary / Q000601:surgery; D014682:Vena Cava, Inferior / Q000601:surgery