Outcomes of resection of giant hepatocellular carcinoma in a tertiary institution: does size matter?
BACKGROUND
The surgical management of giant hepatocellular carcinoma (G-HCC), or HCC of ≥10 cm in diameter, remains controversial. The aim of this study was to compare the outcomes of surgical resection of, respectively, G-HCC and small HCC (S-HCC), or HCC measuring <10 cm.


METHODS
A retrospective review of all patients (n = 86) diagnosed with HCC and submitted to resection in a tertiary hospital during the period from January 2007 to June 2012 was conducted. Overall survival (OS), recurrence rates and perioperative mortality at 30 days were compared between patients with, respectively, G-HCC and S-HCC. Prognostic factors for OS were analysed.


RESULTS
The sample included 23 patients with G-HCC (26.7%) and 63 with S-HCC (73.3%) based on histological tumour size. Patient demographics and comorbidities were comparable. Median OS was 39.0 months in patients with G-HCC and 65.0 months in patients with S-HCC (P = 0.213). Although size did not affect OS in this cohort, the presence of satellite lesions [hazard ratio (HR) 3.70, P = 0.012] and perioperative blood transfusion (HR 2.85, P = 0.015) were negative predictors for OS.


CONCLUSIONS
Surgical resection of G-HCC provides OS comparable with that after resection of S-HCC.
Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore.
Yongxian
http://orcid.org/0000-0002-5495-5780
Y
Thng
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Jarrod K H
JK
Tan
Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore.
Iyer G
IG
Shridhar
Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore.
Stephen K Y
SK
Chang
Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore.
Krishnakumar
K
Madhavan
Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore.
Alfred W C
AW
Kow
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D008099:Liver / Q000033:anatomy & histology* / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D062606:Tertiary Care Centers; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome