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Published on: March 10, 2023
Is hepatectomy for huge hepatocellular carcinoma (≥ 10 cm in diameter) safe and effective? A single-center experience
Jian Yang1, Chuan Li, Tian-Fu Wen
1Department of Liver Surgery and Liver Transplantation, West China Hospital, Sichuan University, Chengdu, China
Insights
Hepatectomy is a safe treatment for huge hepatocellular carcinoma (HCC), comparable to large and small tumors. Long-term survival and disease-free survival for huge HCC are similar to large HCC.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Hepatocellular carcinoma (HCC) is a major global health concern.
- Surgical resection via hepatectomy is a primary treatment for HCC.
- The safety and efficacy of hepatectomy for huge HCC (≥ 10 cm) require further validation.
Purpose of the Study:
- To evaluate the safety and effectiveness of hepatectomy for huge HCC.
- To compare outcomes of hepatectomy for huge, large (5-10 cm), and small (<5 cm) HCC.
- To identify prognostic factors influencing survival after HCC resection.
Main Methods:
- Retrospective review of patients undergoing hepatectomy for HCC (2006-2012).
- Patients categorized into huge (≥ 10 cm), large (5-10 cm), and small (<5 cm) HCC groups.
- Comparison of pre-operative characteristics, post-operative mortality, laboratory data, and survival rates (OS, DFS).
Main Results:
- Pre-operative characteristics were similar across groups, except for alpha-fetoprotein (AFP).
- No significant differences in 30, 60, or 90-day post-operative mortality or early laboratory values.
- Five-year overall survival and disease-free survival were lower for huge and large HCC compared to small HCC, but similar between huge and large HCC groups.
- Independent poor prognostic factors for OS included AFP level, macrovascular invasion, Edmondson-Steiner grade, surgical margin, and Ishak score.
- Independent prognostic factors for DFS included AFP level, macrovascular invasion, microvascular invasion, and surgical margin.
Conclusions:
- Hepatectomy for huge HCC demonstrates comparable safety to that for large and small HCC.
- Hepatectomy for huge HCC may yield similar long-term overall survival and disease-free survival outcomes as for large HCC.
- Prognostic factors like AFP, tumor invasion, grade, and surgical margin significantly impact survival after HCC resection.
Background:
This retrospective study aimed to validate the safety and effectiveness of hepatectomy for huge hepatocellular carcinoma (HCC).
Materials And Methods:
Data of patients who underwent hepatectomy for HCC between January 2006 and December 2012 were reviewed. The patients were divided into three groups: huge HCC(≥ 10 cm in diameter), large HCC(≥ 5 but<10 cm in diameter) and small HCC(<5 cm in diameter).
Results:
Characteristics of pre-operative patients in all three groups were homogeneously distributed except for alpha fetal protein (AFP)(p<0.001).The 30, 60, 90-day post-operative mortality rates were not different among the three groups (p=0.785, p=0.560, and p=0.549). Laboratory data at 1, 3, and 7 days after surgery also did not vary. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) rates in the huge and large HCC groups were lower than that of the small HCC group (OS: 32.5% vs 36.3% vs 71.2%, p=0.000; DFS: 20.0% vs 24.8% vs 40.7%, p=0.039), but there was no difference between the huge and large HCC groups (OS: 32.5% vs 36.3%, p=0.667; DFS: 20.0% vs 24.8%, p=0.540). In multivariate analysis, five independent poor prognostic factors that affected OS were significantly associated with worse survival (p<0.05), namely, AFP level, macrovascular invasion, Edmondsone Steiner grade, surgical margin and Ishak score. AFP level, macrovascular invasion, microvascular invasion, and surgical margin influenced disease-free survival independently (p<0.05).
Conclusions:
The safety of hepatectomy for huge HCC is similar to that for large and small HCC; and this approach for huge HCC may achieve similar long-term survival and disease-free survival as for large HCC.
