Page 206 - ebook HCC

PROGRAMME
204
204 PROGRAMME AND ABSTRACTSAND ABSTRACTS GENEVA, SWITZERLAND EASL HCC SUMMIT 205
FEBRUARY 13 - 16, 2014

Poster Board Number C7

EXPERIENCES WITH LARGE HEPATOCELLULAR NOTES
CARCINOMA: JAKARTA PERSPECTIVE

Adianto Nugroho , Toar Lalisang 1
1
1 Department of Surgery, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Corresponding author’s e-mail: adiyusuf97@gmail.com

Introduction: Since tumor size is closely related to survival and recurrence of hepatocellular
carcinoma (HCC), management guidelines often rely on this factor in selection of the most
appropriate treatment. Consequently, in many established guidelines, large HCC might be
considered not suitable for surgical resection. However, in areas where diagnosis of early
HCC is something rare, partly due to lack of surveillance and low patient awareness of
the disease, most patients present with a large tumor size and decreased liver function.
Fortunately, some of them are resectable in term of no vascular extension and adequacy
of future liver remnant.

Aims: We did a retrospective study of HCC patient underwent surgical resection in Cipto
Mangunkusumo Hospital, Faculty of Medicine University of Indonesia from January 2012
- June 2013

Results: We reported our experience with 9 cases of large HCC in our center. The median
age was 65 (range 38 – 78) years old, with male predominancy. The tumor was mainly
located in the left hemiliver (66.67%) with mean diameter of 13.89 ± 5.73 cm. Preoperative
Trans-arterial Chemo Embolization was performed in 3 patients (33.3%). One case had
a histopathologic HCC grade IV, 4 grade III and 4 grade II. Cirrhosis of the remaining
CLINICAL POSTER ABSTRACTS because of multicentricity. CLINICAL POSTER ABSTRACTS
liver was found in 4 cases and fibrosis in 5 others. P53 expression was presence in all
cases. No perioperative mortality with only one patient known to have recurrence, possibly

Conclusions: A large size tumor is associated with risk of spontaneous rupture, major
vascular invasion, extra-hepatic metastasis, and inadequate remnant liver. Although
the risk of postoperative liver failure and recurrence might increase, surgical resection
should never be discouraged for large HCC, because it offers considerable advantage
for the patient. Relief of severe pain, diminished risk of rupture, and possibility of cure
are entitled with resection. In summary, surgery for resectable large HCC is feasible with
regards to good patient selection and comprehensive perioperative management in a
multidisciplinary team.