Efficacy of major hepatectomy for large hepatocellular carcinoma.

Background/aims: Large hepatocellular carcinomas (HCC) with diameter >10 cm reportedly displays poor prognosis. The role of hepatic resection in the treatment of large HCC remains controversial. We evaluated the efficacy of hepatic resection, particularly major hepatectomy, for large HCC.

Methodology: From January 1987 to December 2004, a total of 252 patients with primary HCC underwent hepatic resection in our institution. The 22 patients with HCC > or =10 cm (Group A) were compared with the 230 patients with HCC <10 cm (Group B) in terms of clinicopathological factors and prognosis.

Results: Serum alpha-fetoprotein level was significantly higher in Group A than in Group B (p=0.004) and populations of patients with portal vein invasion, hepatic vein invasion and satellite nodules were significantly higher in Group A than in Group B (p<0.001; p<0.001; p=0.034. The 5-year survival rate was worse for Group A (45.2%; median survival, 25 months) than for Group B (67.8%; median survival, 48.2 months). Major hepatic resection (>2 segments) was the only prognostic factor for overall survival in patients with large HCC (p=0.024). Five-year survival rate was significantly better for patients with major hepatectomy (58.3%; median survival, 30.0 months) than for patients with minor hepatic resection (16.7%; median survival, 7.1 months). Liver cirrhosis and early recurrence were significantly less frequent in the major hepatectomy group than in the minor hepatectomy group (p=0.026; p=0.005). Hepatic resection for large HCC could be performed with zero mortality.

Conclusions: Major hepatectomy can improve prognosis while preserving liver function for patients with large HCC.