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

AbstractBACKGROUND:
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.
AuthorsKazuaki Shimada, Yoshihiro Sakamoto, Minoru Esaki, Tomoo Kosuge
JournalLangenbeck's archives of surgery (Langenbecks Arch Surg) Vol. 393 Issue 4 Pg. 521-6 (Jul 2008) ISSN: 1435-2451 [Electronic] Germany
PMID18188585 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular (mortality, pathology, surgery)
  • Disease Progression
  • Disease-Free Survival
  • Female
  • Hepatectomy (methods)
  • Humans
  • Japan
  • Kaplan-Meier Estimate
  • Liver Neoplasms (mortality, pathology, surgery)
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Neoplasm, Residual (mortality, pathology, surgery)
  • Neoplasms, Multiple Primary (mortality, pathology, surgery)
  • Neoplastic Cells, Circulating (pathology)
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Tumor Burden
  • Young Adult

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