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Invited Critique
June 16, 2008

Treatment of Stage IVA Hepatocellular Carcinoma—Invited Critique

Arch Surg. 2008;143(6):543. doi:10.1001/archsurg.143.6.543

The report by Chirica et al retrospectively analyzes the outcomes of 20 patients who underwent surgical resection of stage IVA HCC, representing 16% of the 128 patients overall who underwent surgical treatment of HCC at this center. These patients had advanced-stage disease with a median number of 3 resected tumors per patient and a median diameter of the largest tumor of 6 cm. Five patients had major portal venous involvement and 2 had associated inferior vena cava invasion that required operative reconstruction. All patients had at least severe fibrosis in the nontumor-bearing liver with 60% having biopsy-proven cirrhosis. Impressively, Chirica et al report an operative mortality rate of only 5% with a 30% morbidity rate in this group of high-risk, advanced-stage tumors.

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