Surgical Management of Large Hepatocellular Carcinoma

The surgical treatment of large hepatocellular carcinoma (HCC), commonly defined as tumours exceeding 5 cm in diameter, remains a cornerstone of curative intent despite advances in locoregional and systemic therapies. Hepatectomy offers the greatest chance of long-term survival, yet its application is constrained by underlying liver function, tumour extent and the risk of postoperative liver failure. Recent developments in patient selection criteria, perioperative care and adjunctive strategies such as portal vein embolisation have broadened the pool of candidates for resection. Techniques to assess remnant liver volume and functional reserve—including indocyanine green clearance and radiomics‐based nomograms—have refined preoperative planning. Moreover, the debate over the staging allocation of single large HCC within established systems has underscored the need to tailor treatment according to biology rather than size alone. Combined approaches, in which transarterial chemoembolisation (TACE) precedes or follows resection, aim to downstage tumours and reduce recurrence, while evolving minimally invasive strategies seek to lower perioperative morbidity. The global burden of large HCC and heterogeneous surgical resources demand robust predictive models and multidisciplinary collaboration to optimise outcomes.

Research from Nature Portfolio

Recent studies have clarified the prognostic impact of tumour size on outcomes after curative liver resection for solitary HCC in cirrhotic patients without macrovascular invasion. Larger tumours (> 5 cm) were associated with poorer recurrence‐free and overall survival, supporting the use of size thresholds alongside histological assessment of cirrhotic severity in stratifying postoperative risk. Propensity score matching confirmed that tumour diameter beyond 5 cm remained an independent predictor of recurrence. In a separate analysis comparing liver resection with TACE for huge HCCs (≥ 10 cm), resection afforded superior long‐term survival without significantly increased 30-day mortality after matching for baseline characteristics. These findings establish surgical resection as the preferred initial approach when feasible, even for very large tumours, and underscore the value of rigorous matching techniques to mitigate selection bias.

Surgical Management of Large Hepatocellular Carcinoma publication trend

The graph below shows the total number of articles in surgical management of large hepatocellular carcinoma across all publications each year (not limited to Nature Index journals).

Technical terms

Hepatectomy: Surgical removal of a portion of the liver, ranging from segmental resection to extended hepatectomy, performed to excise malignancy while preserving sufficient functional liver mass.

Transarterial Chemoembolization (TACE): A locoregional therapy involving the infusion of chemotherapeutic agents and embolic particles into the hepatic artery to induce tumour ischaemia and cytotoxicity.

Barcelona Clinic Liver Cancer (BCLC) Staging: A widely accepted classification system that stages HCC by tumour burden, liver function and performance status to guide treatment recommendations.

Propensity Score Matching: A statistical technique that pairs treated and untreated patients with similar baseline characteristics to reduce confounding in comparative observational studies.

Microvascular Invasion: The presence of tumour cells within small blood vessels adjacent to the primary lesion, an adverse pathological feature associated with higher recurrence risk.

References

1. Tumor size may influence the prognosis of solitary hepatocellular carcinoma patients with cirrhosis and without macrovascular invasion after hepatectomy. Scientific Reports (2021).
2. Liver resection versus transarterial chemoembolization for huge hepatocellular carcinoma: a propensity score matched analysis. Scientific Reports (2021).
3. Solitary Large Hepatocellular Carcinoma: Staging and Treatment Strategy. PLOS ONE (2016).
4. Prognosis after resection of single large hepatocellular carcinoma: Results from an Asian high-volume liver surgery center. PLOS ONE (2020).
5. Survival Analysis of Single Large (>5 cm) Hepatocellular Carcinoma Patients: BCLC A versus B. PLOS ONE (2016).
6. CT radiomics nomogram for the preoperative prediction of severe post-hepatectomy liver failure in patients with huge (≥ 10 cm) hepatocellular carcinoma. World Journal of Surgical Oncology (2021).
7. Multi‐institutional validation of novel models for predicting the prognosis of patients with huge hepatocellular carcinoma. International Journal of Cancer (2021).