Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2021; 13(5): 476-492
Published online May 27, 2021. doi: 10.4240/wjgs.v13.i5.476
Liver resection for hepatocellular carcinoma larger than 10 cm: A multi-institution long-term observational study
Chao-Wei Lee, Ming-Chin Yu, Chih-Chi Wang, Wei-Chen Lee, Hsin-I Tsai, Feng-Che Kuan, Chun-Wei Chen, Yi-Chung Hsieh, Hsing-Yu Chen
Chao-Wei Lee, Ming-Chin Yu, Wei-Chen Lee, Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan
Chao-Wei Lee, Ming-Chin Yu, Wei-Chen Lee, Hsin-I Tsai, Chun-Wei Chen, Yi-Chung Hsieh, College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
Chao-Wei Lee, Ming-Chin Yu, Hsin-I Tsai, Hsing-Yu Chen, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan 333, Taoyuan, Taiwan
Ming-Chin Yu, Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), Tu-Cheng 236017, New Taipei City, Taiwan
Chih-Chi Wang, Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
Chih-Chi Wang, Division of General Surgery, Department of Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
Hsin-I Tsai, Department of Anesthesiology, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan
Feng-Che Kuan, Department of Hematology and Oncology, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
Chun-Wei Chen, Yi-Chung Hsieh, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan
Hsing-Yu Chen, Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Taoyuan Chang Gung Memorial Hospital, Guishan 33378, Taoyuan, Taiwan
Hsing-Yu Chen, School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
Author contributions: Lee CW designed the study, conducted the research, and drafted the manuscript; Yu MC, Wang CC, and Lee WC performed the operations, formulated the concept, supervised the study, and revised the manuscript; Tsai HI and Kuan FC confirmed the statistics, interpreted the data, and revised the manuscript; Chen CW and Hsieh YC collected the data and analyzed the results; Chen HY coordinated the entire study, performed the statistics, and approved the manuscript; All authors read and approved the final manuscript.
Supported by Chang Gung Memorial Hospital, No. CMRPG3J1691.
Institutional review board statement: This study was approved by the Institutional Review Boards (No. 202000608B0) of Chang Gung Memorial Hospital. For retrospective study, informed consent was waived according to our institutional guideline.
Conflict-of-interest statement: Authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hsing-Yu Chen, MD, Associate Professor, Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Taoyuan Chang Gung Memorial Hospital, No. 123 Dinghu Road, Guishan District, Guishan 33378, Taoyuan, Taiwan. b8705016@gmail.com
Received: January 29, 2021
Peer-review started: January 29, 2021
First decision: March 6, 2021
Revised: March 13, 2021
Accepted: April 28, 2021
Article in press: April 28, 2021
Published online: May 27, 2021
Processing time: 111 Days and 22.6 Hours
ARTICLE HIGHLIGHTS
Research background

The treatment of hepatocellular carcinoma (HCC) larger than 10 cm remains challenging. The Chang Gung Research Database (CGRD) contains all medical records of the Chang Gung Memorial Foundation and has become one of the largest clinical databases worldwide. By utilizing the data from CGRD, we attempted to analyze the outcome of HCC larger than 10 cm.

Research motivation

Owing to advancement in surgical technique and perioperative care, the surgical risks associated with liver resection are decreasing in the recent decades. However, the surgical outcome regarding HCC larger than 10 cm has not been updated.

Research objectives

We aimed to consolidate the role of surgical resection for HCC larger than 10 cm. The survival outcomes between surgery and transarterial chemoembolization (TACE) were also compared.

Research methods

Eligible HCC patients were identified from the CGRD, and two models were adopted: The surgical outcome between HCC ≥ 10 cm (L-HCC) and HCC < 10 cm (S-HCC) (model 1); the survival of L-HCC after either liver resection or TACE (model 2). To eliminate the potential confounding bias originating from heterogeneous baseline features and disproportionate case numbers, inverse-probability of treatment weighting between different groups was adopted.

Research results

Although worse than the S-HCC, the surgical and long-term oncological outcome of L-HCC had improved in the recent decades. Moreover, surgery could provide a better survival outcome for L-HCC than TACE.

Research conclusions

With acceptable performance status and liver functional reserve, we suggest liver resection should be conducted for HCC larger than 10 cm. Due to its inferior survival, T1 stage should be further sub-divided to predict precisely patient outcome.

Research perspectives

The current study demonstrated the inferior survival of L-HCC. The necessity of adjuvant therapy following liver resection for L-HCC should thus be determined by further randomized controlled trials.