Liver resection for complicated hepatocellular carcinoma: Challenges but opportunity for long-term survivals

Background Hepatocellular carcinoma (HCC) is often diagnosed late because of the lack of pathognomonic symptoms. This study evaluated outcomes following liver resection (LR) for patients with HCC presenting with large tumor size (over 10?cm), adjacent organ invasion, or ruptured tumor, which we termed as complicated HCC (cHCC). Materials and Methods We retrospectively reviewed 660 HCC patients who underwent LR between January 2001 and July 2005. The patients were grouped into cHCC and non-cHCC according to the defined criteria. The clinicopathological features were analyzed and compared between the two groups. Results Patients in the cHCC group required longer operative times and resulted in greater intraoperative blood loss and more severe surgical complications. The cHCC group had a higher incidence of HCC recurrence after LR, and the HCC recurrence had a tendency to be associated with extrahepatic metastasis. The 5-year RFS (P?<?0.0001) and OS (P?<?0.0001) of cHCC and non-cHCC patients were 18.5% and 28.9% versus 37.5% and 57.6%, respectively. Conclusions LR for cHCC can be a great challenge for liver surgeons. However, with comparable operative mortality rates and acceptable survival times, surgical resection should always be considered performing in patients with cHCC, if clinically feasible. J. Surg. Oncol. 2012; 106: 959965. (c) 2012 Wiley Periodicals, Inc.