title: Hepatectomy for hepatocellular carcinoma larger than 10 cm: preoperative risk stratification to prevent futile surgery.
abstract: OBJECTIVE
  Appropriate patient selection is important to achieving good outcomes and obviating futile surgery in patients with huge (≥10 cm) hepatocellular carcinoma (HCC). The aim of this study was to identify independent predictors of futile outcomes, defined as death within 3 months of surgery or within 1 year from early recurrence following hepatectomy for huge HCC.
  
  
  METHODS
  The outcomes of 149 patients with huge HCCs who underwent resection during 1995-2012 were analysed. Multivariate logistic regression analysis was performed to identify preoperative independent predictors of futility.
  
  
  RESULTS
  Independent predictors of 3-month mortality (18.1%) were: total bilirubin level >34 μmol/l [P = 0.0443; odds ratio (OR) 16.470]; platelet count of <150 000 cells/ml (P = 0.0098; OR 5.039), and the presence of portal vein tumour thrombosis (P = 0.0041; OR 5.138). The last of these was the sole independent predictor of 1-year recurrence-related mortality (17.2%). Rates of recurrence-related mortality at 3 months and 1 year were, respectively, 6.3% and 7.1% in patients with Barcelona Clinic Liver Cancer (BCLC) stage A disease, 12.5% and 14% in patients with BCLC stage B disease, and 37.8% (P = 0.0002) and 75% (P = 0.0002) in patients with BCLC stage C disease.
  
  
  CONCLUSIONS
  According to the present data, among patients submitted to hepatectomy for huge HCC, those with a high bilirubin level, low platelet count and portal vein thrombosis are at higher risk for futile surgery. The presence of portal vein tumour thrombosis should be regarded as a relative contraindication to surgery.
authors.affiliation: Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique (Department of Hepatopancreatobiliary Surgery and Liver Transplantation), Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Henri Mondor, Créteil, France.|Unité 965, Institut National de la Santé et de la Recherché Médicale (Inserm) (National Institute for Health and Medical Research), Paris, France.
authors.forename: Chetana
authors.initials: C
authors.lastname: Lim
authors.affiliation: Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique (Department of Hepatopancreatobiliary Surgery and Liver Transplantation), Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Henri Mondor, Créteil, France.|Unité 955, Inserm, Créteil, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Compagnon
authors.affiliation: Centre Hépato-Biliaire (Hepatobiliary Centre), AP-HP Hôpital Paul Brousse, Villejuif, France.
authors.forename: Mylène
authors.initials: M
authors.lastname: Sebagh
authors.affiliation: Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique (Department of Hepatopancreatobiliary Surgery and Liver Transplantation), Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Henri Mondor, Créteil, France.
authors.forename: Chady
authors.initials: C
authors.lastname: Salloum
authors.affiliation: Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique (Department of Hepatopancreatobiliary Surgery and Liver Transplantation), Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Henri Mondor, Créteil, France.|Unité 955, Inserm, Créteil, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Calderaro
authors.affiliation: Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique (Department of Hepatopancreatobiliary Surgery and Liver Transplantation), Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Henri Mondor, Créteil, France.|Unité 955, Inserm, Créteil, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Luciani
authors.affiliation: Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique (Department of Hepatopancreatobiliary Surgery and Liver Transplantation), Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Henri Mondor, Créteil, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Pascal
authors.affiliation: Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique (Department of Hepatopancreatobiliary Surgery and Liver Transplantation), Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Henri Mondor, Créteil, France.|Unité 955, Inserm, Créteil, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
authors.affiliation: Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique (Department of Hepatopancreatobiliary Surgery and Liver Transplantation), Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Henri Mondor, Créteil, France.|Unité 955, Inserm, Créteil, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Levesque
authors.affiliation: Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique (Department of Hepatopancreatobiliary Surgery and Liver Transplantation), Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Henri Mondor, Créteil, France.|Hepatobiliary Surgery and Liver Transplant Unit, Ospedale Maggiore Policlinico Milano, Milano, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Maggi
authors.affiliation: Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique (Department of Hepatopancreatobiliary Surgery and Liver Transplantation), Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Henri Mondor, Créteil, France.|Unité 955, Inserm, Créteil, France.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Feray
authors.affiliation: Centre Hépato-Biliaire (Hepatobiliary Centre), AP-HP Hôpital Paul Brousse, Villejuif, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
authors.affiliation: Centre Hépato-Biliaire (Hepatobiliary Centre), AP-HP Hôpital Paul Brousse, Villejuif, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.affiliation: Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique (Department of Hepatopancreatobiliary Surgery and Liver Transplantation), Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Henri Mondor, Créteil, France.|Unité 955, Inserm, Créteil, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005602:France; D017048:Health Care Costs; D006498:Hepatectomy / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D018447:Medical Futility; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D018579:Patient Selection; D010976:Platelet Count; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D001663:Bilirubin