Management of Huge HCC: Surgical Resection versus TACE-A Ten-Year Experience in a Single Institution

Background: Treatment for huge or 10 cm and larger hepatocellular carcinoma (HCC) is complex with regards to the size and multifocality of this tumor. Treatment options include surgical resection or transarterial chemoembolization (TACE). Objective: To evaluate the outcomes of surgical resection and TACE in management of huge HCC. Materials and Methods: Between 2010 and 2019, 154 huge HCC patients with potentially resectable tumors were enrolled and evaluated by a multidisciplinary team (MDT) for treatment plans between surgical resection and TACE. The clinicopathological characteristic and overall survival (OS) between surgical resection and TACE were collected and analyzed. Results: After MDT review, 115 patients were eligible for management. Sixty-three patients underwent surgical resection. TACE was performed in 52 patients. Patients in the surgical resection group had less severe comorbid disease with 14 patients (22.2%) versus 28 patients (53.8%) (p<0.001], less incidence of cirrhosis at 40 patients (63.5%) versus 45 patients (86.5%), (p=0.005) and less incidence of portal vein tumor thrombus at 11 patients (17.5%) versus 21 patients (40.3%), (p=0.003) compared to patients in the TACE group. The 1-, 3-, 5-year OS rates for surgical resection were 81%, 54%, and 39%, and 10.2%, 8.2%, and 2% in the TACE group (p<0.001) with mean follow up of four years. Morbidity and mortality rate in surgical resection were 34.9% and 1.5%, respectively. Posthepatectomy grade C complication was zero. Conclusion: Surgical resection in huge HCC in selected cases achieve better outcomes than TACE with acceptable morbidity and mortality rate. Keywords: Surgical resection; Huge Hepatocellular carcinoma; Transarterial chemoembolzation