Hepatic resection for large hepatocellular carcinoma

Background: Long-term survival and prognostic factors after hepatic resecti on for large hepatocellular carcinoma (HCC) remain to be proved. Methods: The surgical outcome in 133 consecutive patients with HCC in diame ter of greater than or equal to5 cm (large HCC; L group) undergoing hepatic resection was retrospectively clarified and compared with that of 253 pati ents with HCC in diameter of <5 cm (small HCC; S group). Postresection prog nostic factors were evaluated by univariate and multivariate analysis using Cox's proportional hazards model. Results: The disease-free 3- and 5-year survival rates between L group and S group were 26% versus 42% and 20% versus 25%, respectively (P = 0.0032). The overall 3- and 5-year survival rates between L group and S group were 3 8% versus 67% and 28% versus 47%, respectively (P <0.0001). Multivariate an alysis revealed that large amount of intraoperative blood transfusion was a n independently significant factor of poor disease-free and overall surviva ls. Conclusions: Long-term survival in patients with large HCC remains unsatisf actory compared with that in patients with non-large HCC. Restriction of in traoperative blood transfusion may play an important role in the improvemen t of survival and recurrence in such patients. (C) 2001 Excerpta Medica, In c. All rights reserved.