Objective: To investigate the methods of surgical treatment for large primary liver cancer (LPLC).
Methods: The clinical data of 180 patients with large LPLC admitted to our hospital from January 2002 to December 2009 were retrospectively reviewed. The presence of cirrhosis, tumor size, lesion location, clinical stage and comorbidities were analyzed.
Results: All the 180 patients underwent surgical treatment, of whom 170 cases were hepatocellular carcinoma, 7 cases were cholangiocarcinoma and 3 cases were mixed hepatic carcinoma. The average size (maximum diameter) of the tumors was 9 (5.3-26.3) cm and 150 cases were accompanied with cirrhosis. Of the patients, anatomic hepatectomy was performed in 112 cases and non-anatomic hepatectomy was performed in 68 cases; the procedures were performed with pringle maneuver in 88 cases, selective hemihepatic vascular clamping in 62 cases, total hepatic vascular exclusion in 10 cases and without hepatic vascular occlusion in 20 cases, respectively. The incidence of postoperative complications was 13.89% (25/180) and the mortality was rate 1.61% (3/180). The 1- 3- and 5-year overall survival rate of these patients was 76.11%, 48.89% and 30.0%, respectively.
Conclusion: Surgical resection-based comprehensive therapy is the main treatment method for large LPLC, and second-stage resection should be strived for after transcatheter arterial chemoembolization (TACE) for those presenting with formidable large LPLC. The rational choice of hepatic blood flow occlusion is a key to ensure operative success and smooth postoperative recovery.