title: The safety and adequacy of resection on hepatocellular carcinoma larger than 10 cm: A retrospective study over 10 years.
abstract: OBJECTIVE
  Current treatment options for HCC≥10 cm (huge HCC) are limited. Otherwise, the margin status is known as a prognostic factor. Our aim was to determine the safety, effectiveness, and risk factors for overall survival and disease-free survival for these patients.
  
  
  METHODS
  A total of 211 consecutive patients from 2000/08 to 2010/12 were enrolled. Characteristics of patients, tumors, and treatment were compared between the huge group (HCCs; ≥10 cm, n = 23; 11%) and those with smaller group (HCC; <10 cm n = 188; 89%). Disease-free survival (DFS), overall survival (OS), and risk factors were analyzed.
  
  
  RESULTS
  Median follow up was 37 months. Patients with huge HCC were more likely to be symptomatic, positive for preoperative portal vein thrombosis, longer surgical time, more blood loss and transfusions, and significantly shorter median OS and DFS. Both groups had similar postoperative mortality and morbidity rates. In the huge HCC, multivariate analysis identified two significant determinants of DFS (preoperative portal vein thrombosis on imaging and tumor-free margin less than 1 mm) and two significant determinants of OS (age over 80 and preoperative portal vein thrombosis). Even with positive margins, it still had no impact on OS. For DFS, 1 mm free margins appeared to be adequate.
  
  
  CONCLUSIONS
  Tumor-free margin is an independent risk factor for recurrence but has no impact on OS. Surgical margin >1 mm is adequate in patients with tumors ≥10 cm. Postoperative close follow up, especially of distant metastasis, and appropriate treatment of recurrence by a multidisciplinary approach may improve prognosis.
authors.affiliation: Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.2, Minsheng Rd., Dalin Township, Chiayi County 622, Taiwan, ROC.
authors.forename: Jian-Han
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.2, Minsheng Rd., Dalin Township, Chiayi County 622, Taiwan, ROC.
authors.forename: Chang-Kuo
authors.initials: CK
authors.lastname: Wei
authors.affiliation: Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.2, Minsheng Rd., Dalin Township, Chiayi County 622, Taiwan, ROC.
authors.forename: Cheng-Hung
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.2, Minsheng Rd., Dalin Township, Chiayi County 622, Taiwan, ROC.
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Chang
authors.affiliation: Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.2, Minsheng Rd., Dalin Township, Chiayi County 622, Taiwan, ROC ; Department of Surgery, College of Medicine, Tzu Chi University, No.2, Minsheng Rd., Dalin Township, Chiayi County 622, Hualien, Taiwan, ROC.
authors.forename: Ta-Wen
authors.initials: TW
authors.lastname: Hsu
authors.affiliation: Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.2, Minsheng Rd., Dalin Township, Chiayi County 622, Taiwan, ROC ; Department of Surgery, College of Medicine, Tzu Chi University, No.2, Minsheng Rd., Dalin Township, Chiayi County 622, Hualien, Taiwan, ROC.
authors.forename: Wen-Yao
authors.initials: WY
authors.lastname: Yin
keywords: Disease-free survival; Huge HCC; Overall survival; Smaller HCC; Surgical margin