Resection of large hepatocellular carcinoma (≥10 cm): A unique western perspective

Background and Objectives: Few Western centers have surgically treated a high volume of large hepatocellular carcinoma 10 cm or more in diameter. The study aim was to analyze a large Western cohort of these patients, and to present our outcomes in the context of the more extensive Eastern experience. Methods: We retrospectively reviewed all patients at our center receiving partial hepatectomy from January 1992 to August 2010, and analyzed a cohort with hepatocellular carcinoma ≥10 cm in diameter. Results: One hundred thirty patients comprised the cohort. One hundred three (79.2%) of the patients received major anatomic resections, and 23 (17.7%) patients underwent tumor thrombectomy as an adjunct procedure. Perioperative mortality was observed in 9 (6.9%) of cases, but from January 2002 onward, only 2 (2.3%) of the 86 resections performed resulted in a mortality. The survival rate at 1, 3, and 5 years was 56.9%, 30.3%, and 18.8%, respectively; the median survival was 17.0 months. The subgroup of 39 patients without gross vascular invasion and satellite nodules achieved a median survival of 40.3 months. Conclusions: Resection of large hepatocellular carcinoma can be done with safety at a large Western center, and a subgroup of patients will achieve long-term survival.