Hepatic resection for hepatocellular carcinoma involving a single large tumor, multiple tumors or macrovascular invasion

Abstract

To investigate the safety and efficacy of hepatic resection for those patients with large/multinodular hepatocellular carcinoma (HCC) or those involving macrovascular invasion (MVI). PubMed was systematically searched for studies examining the safety and efficacy of hepatic resection for treatment of HCC involving a single large tumor (>5 cm) or multiple tumors (>2), or those involving MVI. The identified 52 studies involving 14 922 patients that investigated the use of hepatic resection for large/multinodular HCC, and 25 studies with 4 412 patients that investigated hepatic resection for HCC with MVI. Median in-hospital mortality of patients with either type of HCC was significantly lower in Asian studies (2.7%) than in non-Asian studies (7.3%, P<0.001). Median overall survival rate was significantly higher for all Asian patients with large/multinodular HCC than for all non-Asian patients both at the time of 1 year (81% vs 65%, P<0.001) and 5 years (42% vs 32%, P<0.001). However, median overall survival rate was similar for Asian and non-Asian patients with HCC involving MVI at the time of 1 year (50% vs 52%, P=0.46) and 5 years (18% vs 15%, P=0.95). There was an increasing trend in 5-year overall survival in patients with either type of HCC. Hepatic resection is reasonably safe and effective for the treatment of large/multinodular HCC and HCC with MVI. The available evidence argues for expanding the indications for hepatic resection in official treatment guidelines.