Critical Appraisal of the Clinical and Pathologic Predictors of Survival After Resection of Large Hepatocellular Carcinoma

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Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. In many Eastern countries, patients with HCCs are often diagnosed as having small tumors because of the widespread implementation of multiple screening modalities.1 Large HCCs—tumors with a diameter of 10 cm or larger—are, however, not uncommon, especially in regions in which screening is not routine.2-4 In particular, the incidence of a large HCC is especially high in patients younger than 40 years.5,6 A large HCC is a significant risk factor for intrahepatic and extrahepatic spread and is believed to decrease disease-free survival and overall survival.3,7-9 Unfortunately, patients with large HCCs are generally not considered candidates for liver transplantation, percutaneous ethanol injection, transcatheter arterial chemoembolization, or radiofrequency ablation.10-13 Hepatic resection, therefore, remains the only tenable treatment option for these patients. Resection of a large HCC, however, is a surgical challenge that can entail a greater operating time, blood loss, and risk of postoperative liver failure.14,15