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Is Hepatic Resection for Large or Multinodular Hepatocellular Carcinoma Justified? Results From a Multi-Institutional Database

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Abstract

Background

The role of surgical resection in patients with large or multinodular hepatocellular carcinoma (HCC) remains unclear. This study evaluated the long-term outcome of patients with hepatic resection for large (>5 cm in diameter) or multinodular (more than three nodules) HCC by using a multi-institutional database.

Methods

The perioperative and long-term outcomes of 404 patients with small HCC (<5 cm in diameter; group 1) were compared with those of 380 patients with large or multinodular HCC (group 2). The prognostic factors in the latter group were analyzed.

Results

The postoperative complication rate (27% vs. 23%; P = .16) and hospital mortality rate (2.4% vs. 2.7%; P = .82) were similar between groups. The overall survival rates were significantly higher in group 1 than group 2 (1 year, 88% vs. 74%; 3 years, 76% vs. 50%; 5 years, 58% vs. 39%; P < .001). Among patients in group 2, five independent prognostic factors were identified to be associated with a worse overall survival: namely, symptomatic disease, presence of cirrhosis, multinodular tumor, microvascular tumor invasion, and positive histological margin.

Conclusions

Hepatic resection can be safely performed in patients with large or multinodular HCC, with an overall 5-year survival rate of 39%. Symptomatic disease, the presence of cirrhosis, a multinodular tumor, microvascular invasion, and a positive histological margin are independently associated with a less favorable survival outcome.

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Acknowledgment

Supported by the Outstanding Young Researcher Award and the Sun C. Y. Research Foundation for Hepatobiliary and Pancreatic Surgery of the University of Hong Kong.

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Authors and Affiliations

  1. Centre for the Study of Liver Disease, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China

    Kelvin K. Ng PhD, Sheung Tat Fan MD & Ronnie T. Poon MS (for TheInternational Cooperative Study Group on Hepatocellular Carcinoma)

  2. Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas

    Jean-Nicolas Vauthey MD, Timothy M. Pawlik MD & Steven A. Curley MD

  3. Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

    Gregory Y. Lauwers MD

  4. Department of Surgery, Hôpital Beaujon, Paris, France

    Jean-Marc Regimbeau MD & Jacques Belghiti MD

  5. Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Iwao Ikai MD & Yoshio Yamaoka MD

  6. Department of Surgery, Mayo Clinic, Rochester, Minnesota

    David M. Nagorney MD

  7. Centre for the Study of Liver Disease, Department of Pathology, The University of Hong Kong, Pokfulam, Hong Kong, China

    Irene O. Ng MD

  8. Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China

    Ronnie T. Poon MS (for TheInternational Cooperative Study Group on Hepatocellular Carcinoma)

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  1. Kelvin K. Ng PhD
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  2. Jean-Nicolas Vauthey MD
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  3. Timothy M. Pawlik MD
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  5. Jean-Marc Regimbeau MD
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  6. Jacques Belghiti MD
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  7. Iwao Ikai MD
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  8. Yoshio Yamaoka MD
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  9. Steven A. Curley MD
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  10. David M. Nagorney MD
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  11. Irene O. Ng MD
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  12. Sheung Tat Fan MD
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  13. Ronnie T. Poon MS
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Correspondence to Ronnie T. Poon MS.

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Ng, K.K., Vauthey, JN., Pawlik, T.M. et al. Is Hepatic Resection for Large or Multinodular Hepatocellular Carcinoma Justified? Results From a Multi-Institutional Database. Ann Surg Oncol 12, 364–373 (2005). https://doi.org/10.1245/ASO.2005.06.004

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