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Langenbecks Arch Surg. 2008 Jul;393(4):521-6. doi: 10.1007/s00423-007-0264-4. Epub 2008 Jan 5.

Role of a hepatectomy for the treatment of large hepatocellular carcinomas measuring 10 cm or larger in diameter.

Author information

1
Department of Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Central Hospital, Tokyo, Japan. kshimada@ncc.go.jp

Abstract

BACKGROUND:

A curative hepatectomy is the mainstay of effective treatment for small hepatocellular carcinoma (HCC), but the treatment of large HCC remains challenging.

MATERIALS AND METHODS:

The possible prognostic factors were retrospectively analyzed in 85 patients with large HCC (> or = 10.0 cm) who all underwent a hepatectomy for HCC between 1988 and 2004. A survival analysis was made by classifying the tumors into four spreading patterns according to the number of tumors and the presence of macroscopic tumor thrombus.

RESULTS:

A positive hepatitis B antigen, the earlier period of hepatectomy, a non-curative hepatectomy, multiple tumors, and portal vein invasion were identified as independent predictors of a poor prognosis. The median survival term and 5-year survival rate of patients with a solitary large HCC without a macroscopic tumor thrombus was 9.8 years and 69.8%, respectively. The tumor spreading patterns according to the number of tumors and the presence of a macroscopic tumor thrombus were statistically associated with a non-curative hepatectomy (p < 0.001). There was a statistical difference among 33 patients with large HCC undergoing a non-curative hepatectomy based on the presence of a macroscopic portal vein invasion (p = 0.0089).

CONCLUSION:

A hepatectomy could yield an excellent long-term survival in patients with a solitary large HCC without a macroscopic tumor thrombus. Even if a curative hepatectomy could not be achieved, a hepatectomy might provide better survival in large HCC patients without a macroscopic tumor thrombus compared in those with macroscopic tumor thrombus.

PMID:
18188585
DOI:
10.1007/s00423-007-0264-4
[Indexed for MEDLINE]

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