Efficacy of major hepatic resection for large hepatocellular carcinoma

BACKGROUND/AIMS: A large hepatocellular carcinoma (HCC) generally carries a poor prognosis despite curative hepatic resection. However, some cases hav e had good outcomes without recurrences. In this study, we investigated the factors which predicted a good prognosis. METHODOLOGY: Sixty-six patients with large HCC greater than 5cm who underwe nt curative hepatic resections were divided into two groups. There were 55 patients who had recurrences within 5 years after surgery (group A) and 11 patients who did not have recurrences at the fifth year after surgery (grou p B). We compared the clinicopathological features between the two groups. RESULTS: No differences were seen in the pre-operative liver function tests and the incidence of histological cirrhosis. The incidence of positive rat e of histological recurrence factors, such as intrahepatic metastasis and i ncomplete surgical margins, was significantly less in group B. Five (45%) a nd 10 (91%) of 11 patients in group B underwent pre-operative portal vein e mbolization and major hepatic resection, respectively, while 10 (18%) and 2 9 (53%) of 55 patients in group A underwent these procedures (p<0.05). CONCLUSIONS: In order to increase tumor-free survival rates for patients wi th large HCC greater than 5cm, major hepatic resection after portal vein em bolization with complete surgical margins should be performed.