Surgical Strategies and Tumor-free Survival in Large Hepatocellular Carcinoma

Abstract

Eighty-three patients with large hepatocellular carcinoma (>5cm), who underwent hepatic resections were analyzed for 30 clinicopathologic variables related to tumor-free survival after surgery. Univariate analysis showed that major hepatic resection (n=49), singlenodular case (n=41), no portal invasion (n=75), no intrahepatic metastasis (n=36), complete surgical margin (n=36) and curative operation (n=25) were significant independent factors for longer tumor-free survival. Using multivariate analysis, only no intrahepatic metastasis on its own found to be an independent factor. Although 16 of 49 patients with majorhepatic resec-tion underwent percutaneous transhepatic portal embolization before surgery, it was not an independent prognostic factor in tumor-free survival. In order to have a long tumor-free survival for large HCCs, curative major hepatic resection with a complete surgical margin seemed to be necessary. Percutaneous transhepatic portal embolization may contribute to extension of surgical indications for large HCCs.