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

¹ Centre for the Study of Liver Disease, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China
² Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
³ Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
⁴ Department of Surgery, Hôpital Beaujon, Paris, France
⁵ Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
⁶ Department of Surgery, Mayo Clinic, Rochester, Minnesota
⁷ Centre for the Study of Liver Disease, Department of Pathology, The University of Hong Kong, Pokfulam, Hong Kong, China

Correspondence: Address correspondence and reprint requests to: Ronnie T. Poon, MS, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China; E-mail: poontp{at}hkucc.hku.hk.

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.

Key Words: Hepatectomy • Large • Multinodular • Hepatocellular • Carcinoma

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