Abstract
Aim: This study is to assess tumor size as a prognostic factor predicting outcomes after one staged hepatectomy for cirrhotic patients with solitary hepatocellular carcinoma. Patients and methods: The study included 41 patients with single hepatocellular carcinoma (HCC) of different sizes who underwent single-stage hepatectomy. Patients were divided according to their tumor size into 2 groups, group A involved patient with tumors ≤ 5 cm and group B which involved patients with tumors > 5 cm. The effect of the tumor size on overall survival and disease-free survival was studied in both groups. Results: The mean age of the studied groups was 59.60±6.89 years. Hepatitis C infection was found 82.9% of patients. Six patients (17.1%) received treatment of HCV. All patients were of Child-Pugh class A (77.1% were scores 5 and 22.9% were score 6). The median Alpha-fetoprotein (AFP) level was 240 ng/ml. The mean operative time was 186.4±52.4 min. During the follow-up period (12-24 months), 12 patients (34.3%) developed recurrence. The mean time of recurrence was 15.50±4.23 months. Cumulative disease-free survival (DFS) at the end of the study was 65.7%. The cumulative overall survival (OAS) proportion at the end of the study was 74.3%. Conclusion: Our results suggest that surgical resection for large HCC is safe and effective and that the first-line treatment for large HCC to be considered is surgical resection in selected patients. Our study showed that hepatectomy for large HCC could be performed with an acceptable morbidity and mortality rate. With the improvement in patient selection and treatment strategy, solitary large HCC is not a contraindication to surgical therapy.
Highlights
Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver representing approximately 80% - 90% of primary hepatic malignancies and it represents the 3rd leading cause of neoplasm related deaths worldwide
Barcelona Clinic Liver Cancer (BCLC) has been approved as guidance for HCC treatment algorithms by the European Association for the Study of Liver (EASL) and the American Association for the Study of Liver Disease (AASLD), BCLC algorithm suggests that resection only in small lesions (5 cm [6]
Patients included were: BCLC stage (0- A-B), Child-Pugh A liver disease, Cirrhotic patients with solitary HCC which is defined as any single lesion of any size without satellite nodules and/or macrovascular invasion at the time of preoperative assessment, Technically respectable tumors, A remnant liver volume of at least 40% was suitable for HCC ≥5 cm requiring formal anatomical hepatectomy
Summary
Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver representing approximately 80% - 90% of primary hepatic malignancies and it represents the 3rd leading cause of neoplasm related deaths worldwide. HCC is usually associated with cirrhosis whose major cause is viral hepatitis [1]. Liver resection is the mainstay treatment for the majority of HCCs due to organ shortage [4]. Barcelona Clinic Liver Cancer (BCLC) has been approved as guidance for HCC treatment algorithms by the European Association for the Study of Liver (EASL) and the American Association for the Study of Liver Disease (AASLD), BCLC algorithm suggests that resection only in small lesions (
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