الفهرس 
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Abstract
SUMMARY : Hepatocellular carcinoma (HCC) represents the sixth most common cancer worldwide. In Egypt, it represents the fourth common cancer. Many hospital-based studies reported increasing the incidence of HCC. The tumor size is assumed to be one of the most important prognostic factors for HCC. Several reports have shown that patients with huge HCC tumors have poor clinical outcomes due to early intrahepatic recurrence and distant metastasis. To the best of our knowledge, although the current literature is rich with studies handling HCC diagnosis and management, there is a clear paucity of studies focusing on the optimum treatment plan for patients with single large HCC. The current study was conducted at Mansoura University Gastrointestinal Surgery Center (GISC) aiming to evaluate the surgical outcome after partial hepatectomy for HCC regarding tumour characteristics, surgical strategies, morbidity, mortality, survival and recurrence. We included a total of 35 cases diagnosed with single HCC lesion > 10 cm. The included cases were subjected to complete history taking, physical examination and routine preoperative laboratory investigations. All cases underwent tumour resection via the open approach. Our results showed the following findings: • The mean age of the included cases was 55.69 years. * We included 24 males (68.6%) in addition to 11 females (31.4%). * The mean BMI of the included participants was 28.98 kg.m2. * systemic comorbidities, diabetes was present in 11.4% of cases, while hypertension was not detected in our cases. * Previous abdominal surgery was reported by 22.9% of cases while previous RFA was done in only one case (2.9%). * The mean value of serum albumin was 3.86 gm/dl while total serum bilirubin had a mean value of 0.98 mg/dl. The mean values of AST and ALT were 111.14 and 87 IU/ml respectively. * The mean value of INR was 1.27. * Platelet count had a mean value of 226.23 while serum creatinine had a mean value of 1.22 mg/dl. * The mean value of serum AFP was 2906.1 ng/ml while it was 1.26 for the CTP score. * Preoperative assessment revealed the presence of cirrhotic liver in 20 cases (57.1%), while the remaining patients had normal liver. * The right lobe was affected in 17 cases (48.6%) while the left lobe was affected in the remaining cases. * Lesions had a mean size of 14.49 cm in the included participants. * Vascular invasion was detected in 6 cases (17.1%) while nearby organ invasion was detected in 5 cases (14.3%). * Lymph node invasion was encountered in 5 cases (14.3%). * Regarding resection type, it was as follows; wedge resection (22.9%), right hepatectomy (37.1%), left hepatectomy (34.4%) and left lateral segmentectomy (5.7%). * Pringle maneuver was performed in 6 cases (17.1%) while the remaining cases had direct vascular control. * The mean duration of operation was 3.97 hours, and blood loss had a mean value of 1822.86 ml in the included cases. * Intraoperative complications were encountered in 5 cases, with massive bleeding encountered in 3 cases and adjacent organ injury in 3 cases (8.6%). * ICU admission was required for 13 cases (37.1%) after operation. * The mean duration of ICU stay was 3.15 days, while it was 12.14 days for the total duration of hospitalization. * Post-operative liver cell failure was encountered in 5 cases (14.3%), four of them were grade i while the remaining were grade ii. * Infiltrated safety margin was encountered in 8 cases (22.9%) while microvascular invasion was detected in 6 cases (17.1%). * Perineural invasion was encountered in 6 cases (17.1%). * Pathological grades 1, 2 and 3 were diagnosed in 8.6, 74.3 and 17.1% of cases respectively. * As regard t classification, most of the included cases had t 2 classification (68.6%), while class 3 was detected in 20% of patients. T class 1 and 4 were detected in 8.6 and 2.9% of cases. * Recurrence was detected in 20 cases (57.1%) while mortality was encountered in 19 cases (54.3%). * Progression free survival had a median value of 13 months while the median duration of overall survival was 26 months. * Progression free survival was detected in 51.4, 42.9 and 42.9% of patients, while overall survival was seen in 97.1, 51.4 and 45.7% after one, two and three years respectively. * Risk factors for recurrence included low BMI, high transaminases, vascular invasion, nearby organ invasion, lymph node invasion and intraoperative blood transfusion along with microvascular invasion, high pathological grade and stage. * Risk factors of mortality included lower BMI, high liver transaminases, macrovascular invasion, lymphatic or nearby organ invasion, intraoperative blood transfusion, high pathological grade, high T class, in addition to recurrence.