Is surgery for large hepatocellular carcinoma justified?

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Hepatocellular Carcinoma Research

Background:

• Hepatocellular carcinoma (HCC) is often diagnosed at advanced stages, precluding treatments like liver transplantation or percutaneous ethanol injection.
• Large HCCs (>8 cm) are typically considered poor candidates for surgical resection.
• This study aimed to re-evaluate surgical outcomes for patients with large HCCs.

Purpose of the Study:

• To compare the short- and long-term outcomes of liver resection for small (<5 cm) versus large (>8 cm) hepatocellular carcinomas.
• To determine if large HCCs necessitate different surgical management strategies.
• To assess the impact of tumor size on survival and recurrence after resection.

Main Methods:

• A retrospective analysis of 256 patients who underwent resection for non-fibrolamellar HCC between 1984 and 1996.
• Patients were categorized into small HCC (<5 cm) and large HCC (>8 cm) groups.
• Comparison of in-hospital mortality, long-term survival, and disease-free survival between the two groups.

Main Results:

• In-hospital mortality rates were similar for both small and large HCC resections (11.5% vs. 10.6%).
• While large HCCs showed a higher risk of early death and recurrence in patients with chronic liver disease, long-term survival (3-5 years) and disease-free survival were comparable (34% vs. 31% and 25% vs. 21% at 5 years, respectively).
• Tumor size did not influence survival or treatment outcomes after recurrence onset.

Conclusions:

• Liver resection is a viable treatment option for patients with large hepatocellular carcinomas.
• Patients with large HCCs should not be excluded from surgical consideration due to tumor size alone.
• Surgical outcomes, including mortality and long-term survival, can be comparable between large and small HCC resections.