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

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 (>= 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.