Liver resection for complicated hepatocellular carcinoma: challenges but opportunity for long-term survivals.
BACKGROUND
Hepatocellular carcinoma (HCC) is often diagnosed late because of the lack of pathognomonic symptoms. This study evaluated outcomes following liver resection (LR) for patients with HCC presenting with large tumor size (over 10 cm), adjacent organ invasion, or ruptured tumor, which we termed as complicated HCC (cHCC).


METHODS
We retrospectively reviewed 660 HCC patients who underwent LR between January 2001 and July 2005. The patients were grouped into cHCC and non-cHCC according to the defined criteria. The clinicopathological features were analyzed and compared between the two groups.


RESULTS
Patients in the cHCC group required longer operative times and resulted in greater intraoperative blood loss and more severe surgical complications. The cHCC group had a higher incidence of HCC recurrence after LR, and the HCC recurrence had a tendency to be associated with extrahepatic metastasis. The 5-year RFS (P < 0.0001) and OS (P < 0.0001) of cHCC and non-cHCC patients were 18.5% and 28.9% versus 37.5% and 57.6%, respectively.


CONCLUSIONS
LR for cHCC can be a great challenge for liver surgeons. However, with comparable operative mortality rates and acceptable survival times, surgical resection should always be considered performing in patients with cHCC, if clinically feasible.
Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Jen-Fu
JF
Huang
Sheng-Mao
SM
Wu
Tsung-Han
TH
Wu
Chen-Fang
CF
Lee
Ting-Jung
TJ
Wu
Ming-Chin
MC
Yu
Kun-Ming
KM
Chan
Wei-Chen
WC
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult