Impact of hepatectomy for huge solitary hepatocellular carcinoma

Background To evaluate the surgical outcome of patients with huge solitary hepatocellular carcinoma (HCC, 10cm in diameter) without major vascular invasion. Methods We retrospectively studied 177 patients with huge HCC (10cm in diameter) who underwent hepatectomy from 1990 to 2008. Surgical outcomes and clinicopathological characteristics were compared among 54 patients with solitary HCC without a major portal vein tumor thrombus (MPVT), 53 patients with multiple HCCs without MPVT, and 70 patients who have HCC with MPVT. Results The mean tumor size and indocyanine green retention rate at 15min showed no significant difference among patients groups. The overall 5-year survival rate was significantly higher in patients with solitary HCC (79%) than in patients with multiple HCCs (31%, P<0.0001) and MPVT (17%, P<0.0001). In patients who underwent curative surgery, the 5-year disease-free survival rate was significantly higher in patients with solitary HCC (48%) than in patients with multiple HCCs (12%, P=0.0008) and MPVT (12%, P=0.0003). Multivariate analysis showed solitary HCC to be a significant independent prognostic factor for overall survival and disease-free survival. Conclusions Patients with solitary HCC without MPVT show a favorable surgical outcome even for tumor size 10cm in diameter. J. Surg. Oncol. 2013;107:408413. (c) 2012 Wiley Periodicals, Inc.