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Multicenter Study
. 2024 Aug 11;409(1):248.
doi: 10.1007/s00423-024-03419-4.

Single large hepatocellular carcinoma > 5 cm with surgical indication: is it mandatory a major hepatectomy? a propensity-score weighted analysis

Mattia Garancini  1 , Matteo Serenari  2   3 , Simone Famularo  4   5 , Federica Cipriani  6 , Francesco Ardito  7 , Nadia Russolillo  8 , Simone Conci  9 , Daniele Nicolini  10 , Pasquale Perri  11 , Matteo Zanello  12 , Maurizio Iaria  13 , Quirino Lai  14 , Maurizio Romano  15   16 , Giuliano La Barba  17 , Sarah Molfino  18 , Paola Germani  19 , Tommaso Dominioni  20 , Giuseppe Zimmiti  21 , Maria Conticchio  22 , Luca Fumagalli  23 , Mauro Zago  24 , Albert Troci  25 , Ivano Sciannamea  26 , Cecilia Ferrari  27 , Mauro Alessandro Scotti  28 , Guido Griseri  27 , Adelmo Antonucci  26 , Michele Crespi  25 , Enrico Pinotti  24 , Marco Chiarelli  23 , Riccardo Memeo  22 , Mohamed Abu Hilal  21 , Marcello Maestri  20 , Paola Tarchi  19 , Gianluca Baiocchi  18 , Giorgio Ercolani  17 , Giacomo Zanus  15   16 , Massimo Rossi  14 , Raffaele Dalla Valle  13 , Elio Jovine  12 , Antonio Frena  29 , Stefan Patauner  29 , Gian Luca Grazi  11 , Marco Vivarelli  10 , Andrea Ruzzenente  9 , Alessandro Ferrero  8 , Felice Giuliante  7 , Luca Aldrighetti  6 , Guido Torzilli  4   5 , Matteo Cescon  2   3 , Davide Bernasconi  30 , Fabrizio Romano  28 ; HE.RC.O.LE.S. Group
Collaborators, Affiliations
Multicenter Study

Single large hepatocellular carcinoma > 5 cm with surgical indication: is it mandatory a major hepatectomy? a propensity-score weighted analysis

Mattia Garancini et al. Langenbecks Arch Surg. .

Abstract

Purpose: Single large hepatocellular carcinoma >5cm (SLHCC) traditionally requires a major liver resection. Minor resections are often performed with the goal to reduce morbidity and mortality. Aim of the study was to establish if a major resection should be considered the best treatment for SLHCC or a more limited resection should be preferred.

Methods: A multicenter retrospective analysis of the HE.RC.O.LE.S. Group register was performed. All collected patients with surgically treated SLHCC were divided in 5 groups of treatment (major hepatectomy, sectorectomy, left lateral sectionectomy, segmentectomy, non-anatomical resection) and compared for baseline characteristics, short and long-term results. A propensity-score weighted analysis was performed.

Results: 535 patients were enrolled in the study. Major resection was associated with significantly increased major complications compared to left lateral sectionanectomy, segmentectomy and non-anatomical resection (all p<0.05) and borderline significant increased major complications compared to sectorectomy (p=0.08). Left lateral sectionectomy showed better overall survival compared to major resection (p=0.02), while other groups of treatment resulted similar to major hepatectomy group for the same item. Absence of oncological benefit after major resection and similar outcomes among the 5 groups of treatment was confirmed even in the sub-population excluding patients with macrovascular invasion.

Conclusion: Major resection was associated to increased major post-operative morbidity without long-term survival benefit; when technically feasible and oncologically adequate, minor resections should be preferred for the surgical treatment of SLHCC.

Keywords: Hepatocellular carcinoma; Large HCC; Major liver resection; Mortality; Overall survival.

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