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Is surgery for large hepatocellular carcinoma justified?

Is surgery for large hepatocellular carcinoma justified?,10.1016/S0168-8278(99)80319-5,Journal of Hepatology,Jean-Marc Régimbeau,Olivier Farges,Bai Yo

Is surgery for large hepatocellular carcinoma justified?   (Citations: 31)
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Background/Aims: Most hepatocellular carcinomas are still discovered at an advanced stage and are left untreated as large hepatocellular carcinomas are contraindications to liver transplantation and percutaneous ethanol injection and are usually considered as poor indications for liver resection. The aim of this study was to reassess the results of surgery in these patients.Methods: Between 1984 and 1996, 256 patients underwent resection of biopsy-proven, non-fibrolamellar hepatocellular carcinoma. Of these, 121 had a tumour diameter of less than 5 cm (small hepatocellular carcinomas) and 94 a tumour diameter of more than 8 cm (large hepatocellular carcinomas). The short- and long-term outcome of patients with small and large hepatocellular carcinomas were compared.Results: The in-hospital mortality rate following resection of small and large hepatocellular carcinomas was comparable (11.5 vs. 10.6%), even after stratifying for the presence and severity of an underlying liver disease. In patients with a chronic liver disease, large hepatocellular carcinomas were associated with a greater risk of death and recurrence during the first 2 operative years. In the long term, however (3–5 years), survival and disease-free survival following resection of small and large hepatocellular carcinomas were comparable (34 vs. 31% and 25 vs. 21% at 5 years). Similarly, treatment of and survival after the onset of recurrence were not influenced by the size of the initial tumour.Conclusions: Patients with large hepatocellular carcinomas should not be abandoned and should be considered for liver resection as this treatment may be associated with an in-hospital mortality rate and a long-term survival comparable to that observed after resection of small hepatocellular carcinomas.
Journal: Journal of Hepatology - J HEPATOL , vol. 31, no. 6, pp. 1062-1068, 1999
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    • ...The prognosis of large hepatocellular carcinoma (LHCC) is generally considered to be worse than small hepatocellular carcinoma (SHCC), but longterm survival of some LHCC, especially solitary large hepatocellular carcinoma (SLHCC), could be frequently observed after curative resection [3-5]...
    • ...Furthermore, some clinical investigation showed that the 5-year survival rate of LHCC after curative resection was not statistically different from SHCC [4,5]...

    Xiang Dinget al. ADAM17 mRNA expression and pathological features of hepatocellular car...

    • ...Up to now, the difficult point is still existing in treatment of large liver cancers, due to worse results and higher risk[14,15]...

    Jing-An Ruiet al. Right trisectionectomy for primary liver cancer

    • ...retrospective studies [6-9] , however, have shown that these macro-morphological features are indirect markers of specific tumor histological characteristics such as grade of differentiation and microscopic vascular invasion which have therefore the potential to refine the HCC prognostic assessment...
    • ...In virtue of such a tight selection philosophy, on one hand it has obtained an important reallocation of resources but on the other it has faced the concrete risk that a considerable proportion of HCC patients have been unfairly excluded from radical treatment [6-8]...

    Umberto Cilloet al. Role of blood AFP mRNA and tumor grade in the preoperative prognostic ...

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