G. Tsoulfas MD, PhD, FACS; A. Mekras MD; P. Agorastou MD, PhD; D. Kiskinis MD, PhD.
Surgical treatment for large hepatocellular carcinoma: does size matter?
Article first published online: 2 MAY 2012
© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons
ANZ Journal of Surgery
Volume 82, Issue 7-8, pages 510–517, July/August 2012
How to Cite
Tsoulfas, G., Mekras, A., Agorastou, P. and Kiskinis, D. (2012), Surgical treatment for large hepatocellular carcinoma: does size matter?. ANZ Journal of Surgery, 82: 510–517. doi: 10.1111/j.1445-2197.2012.06079.x
- Issue published online: 5 AUG 2012
- Article first published online: 2 MAY 2012
- Accepted for publication 20 November 2011.
- disease-free survival;
- large hepatocellular carcinoma (HCC);
- liver resection;
- liver transplantation;
- surgical treatment
Despite significant progress in the management of hepatocellular carcinoma (HCC), patients with large HCC (defined as >10 cm) continue to present a significant challenge. The goal of this paper is to review the existing literature regarding large HCC, with emphasis on identifying the issues and challenges involved in approaching these tumours surgically. A computerized search was made of the Medline database from January 1992 to December 2010. The MESH heading ‘large’ or ‘huge’ in combination with the keyword ‘hepatocellular carcinoma’ was used. After excluding further studies that identified ‘large’ HCC as less than 10 cm and/or sequential publications with overlapping patient populations, the search produced a study population of 22 non-duplicated papers, reporting on a total of 5223 patients with HCC tumours >10 cm. Regarding resection for large HCC, the overall 5-year survival in these studies ranged from 25% to 45%, with few outliers on both sides, whereas in most studies, the 5-year disease-free survival ranged between 15% and 35%, with the only exception being studies with patients with single lesions and no cirrhosis showing disease-free survival of 41% and 56%, respectively. Risk factors identified included vascular invasion, cirrhosis, high level of alpha-fetoprotein and the presence of multiple lesions. Finally, liver transplantation, although an attractive concept, did not appear to offer a survival benefit in any of the studies. In conclusion, identifying the risk factors that affect the outcome in patients undergoing surgery for large HCC is critical. The reason is that surgical resection can have excellent outcomes in carefully selected patients.