Right Hemihepatectomy Using an Anterior Approach Technique for a Hepatocellular Carcinoma >10 cm in Size

PURPOSE: This study was conducted to evaluate the technical feasibility and the impact on survival of the anterior approach technique for resecting a huge hepatocelluar carcinoma (HCC) as compared with the conventional approach technique. METHODS: We performed a retrospective observational study on 57 patients who underwent right hemihepatectomy for a huge HCC over than 10cm in diameter. A total of 57 patients were divided into two groups; the anterior approach technique group (AA group, n=23) and the conventional approach group (CA group, n=34). The overall perioperative data was collected and analyzed. The post-hepatectomy liver function, the operative mortality and morbidity and the survival outcome were compared between the two groups. RESULTS: The post-hepatectomy liver function profile was not significantly different between the two groups. The operative mortality and morbidity were comparable in both groups. The transfusion requirement was not significantly different in both groups (p=0.470), but the cases without transfusion were more common in the AA group (p=0.046). The tumor with an advanced stage (UICC stage III/IV) was significantly more frequent in the AA group (p=0.014). The overall patient survival and disease-free survival was not significantly different between the two groups despite of the difference of the disease stage between the 2 groups (p=0.050, p=0.822). Pulmonary metastasis was more common in the CA group (p=0.035). CONCLUSIONS: Despite of the advanced disease state, the anterior approach technique resulted in comparable operative and survival outcomes as compared with the outcomes of the conventional approach technique. In terms of the technical feasibility, the anterior approach technique may reduce the required amount of transfusion when performing hepatectomy for a huge HCC.

The Outcome after Curative Resection for a Huge (> or = 10cm) Hepatocellular Carcinoma

PURPOSE: Recent studies have reported improved perioperative and long-term outcomes for the initial postoperative results for patients with a huge HCC. The purpose of this study was to investigate the surgical outcomes of patients with a huge HCC and we wanted to identify any subgroup that would likely benefit from hepatic resection. METHODS: From January 1996 to August 2006, 55 patients were diagnosed with a huge HCC (> or = 10cm in diameter). All the tumors were classified as either the expanding nodular type or the non- expanding nodular type. RESULTS: The mean age of the patients was 50.6 years and 39 patients were male. The most common cause of liver disease was hepatitis B virus. The mean size of tumor was 11.9 cm. Microscopic liver cirrhosis was present in 17 patients. Twenty-three patients had tumors of the expanding nodular type. Curative resection was performed in 50 patients. The 5-year diseasefree and overall survival rates after resection were 35.8% and 41.0%, respectively. Univariate analysis revealed that surgical margins of < or = 1.0, a non-curative resection, the non-expanding nodular type and microscopic vascular invasion were adverse prognostic factors for survival. Multivariate analysis indicated that the gross tumor classification (expanding nodular vs. nonexpanding nodular) was the only independent prognostic factor. CONCLUSIONS: Huge HCC is not a homogenous group and the gross tumor pattern may represent the biologic behavior of huge HCC. Because the outcome of surgical treatment is far better than that of non-surgical treatment, resection should be actively considered for patients with a huge HCC. An expanding nodular type tumor is the best candidate for surgical resection.