Large hepatocellular carcinoma: Does fibrosis really impact prognosis after resection?

Summary Background Hepatectomy remains the standard treatment for large hepatocellular carcinoma (LHCC) ≥ 5 cm. Fibrosis may constitute a contraindication for resection because of high risk of post-hepatectomy liver failure, but its impact on patient outcome and cancer recurrence remains ill defined. Our aim was to compare predictors of survival in patients with and without cirrhosis following hepatectomy for LHCC. Methods The data on consecutive patients undergoing hepatectomy for LHCC in two tertiary centres between 2012 and 2016 were reviewed. The outcomes of cirrhotic (F4) and non-cirrhotic (F0–F3) patients were compared. Patients with perioperative medical (sorafenib) or radiological (transarterial chemoembolization, radiofrequency) treatments were excluded. Results Sixty patients were included. Preoperative and intraoperative features were identical between both groups. Cirrhotics ( n = 15) presented more satellite nodules on specimens (73% vs. 44%; P = 0.073) but better differentiated lesions than non-cirrhotics ( P = 0.041). The median overall survival of cirrhotics was 34 vs. 29 months for non-cirrhotics ( P = 0.8), and their disease-free survival was 14 versus 18 months ( P = 0.9). Fibrosis stage did not impact overall ( P = 0.2) nor disease-free survivals ( P = 0.6). Conclusion Hepatectomy for LHCC in cirrhotics can achieve acceptable oncological results when compared to non-cirrhotic patients. Curative resection of LHCC should be attempted if liver function is acceptable, whatever the fibrosis stage. [ABSTRACT FROM AUTHOR]