Is surgery for large hepatocellular carcinoma justified?

Background/Aims: Most hepatocellular carcinomas are still discovered at an advanced stage and are left untreated as large hepatocellular carcinomas ar e contraindications to liver transplantation and percutaneous ethanol injec tion and are usually considered as poor indications for liver resection, Th e aim of this study was to reassess the results of surgery in these patient s. Methods: Between 1984 and 1996, 256 patients underwent resection of biopsy- proven, non-fibrolamellar hepatocellular carcinoma. Of these, 121 had a tum our diameter of less than 5 cm (small hepatocellular carcinomas) and 94 a t umour diameter of more than 8 cm (large hepatocellular carcinomas), The sho rt- and long-term outcome of patients with small and large hepatocellular c arcinomas were compared. Results: The in-hospital mortality rate following resection of small and la rge hepatocellular carcinomas was comparable (11.5 vs, 10.6%), even after s tratifying for the presence and severity of an underlying liver disease, In patients with a chronic liver disease, large hepatocellular carcinomas wer e associated with a greater risk of death and recurrence during the first 2 operative years, In the long term, however (3-5 years), survival and disea se-free survival following resection of small and large hepatocellular carc inomas were comparable (34 vs, 31% and 25 vs, 21% at 5 years), Similarly, t reatment of and survival after the onset of recurrence were not influenced by the size of the initial tumour. Conclusions: Patients with large hepatocellular carcinomas should not be ab andoned and should be considered for liver resection as this treatment may be associated with an in-hospital mortality rate and a long-term survival c omparable to that observed after resection of small hepatocellular carcinom as.