Background : The outcomes of patients with more than 10cm hepatocellular carcinoma remains dismal. Although there are different options available, surgical resection remains the most effective option, especially among countries with limited resources. As such, is worth to determine the oncologic outcomes of patients with more than 10cm resectable hepatocellular carcinoma.

Methods : The data of all patients with more than 10 cm hepatocellular carcinoma who underwent hepatectomy between January 2020 and December 2023 were retrospectively reviewed. The short-term and the long-term survival outcome were analyzed.

Results : Among twenty-four (24) patients, 18 (75%) were males and 6 (25%) females. The mean size of the tumor was 11.8  3.1 cm. The mean operative time and blood loss was 354  87 minutes and 1480  560 mL, respectively. Surgical complications (Clavien-dindo III-V) occurred in 6 (25%) patients. Post operative liver failure, postoperative bleeding, pneumonia, and bile leak were observed in 4 (16.7%), 4(16.7%), 2 (8.3%), and 1 (4.2%) patient, respectively. The mean overall survival was 14 months, while the disease-free survival was 12 months. On multivariable analysis, vascular invasion (HR 3.4, ( CI 3.5 – 1.028), p = 0.045) and AFP ( HR 1.0 ( CI 1.01 – 1.08) were associated with DFS, while the presence of liver cirrhosis (HR 3.04 (CI 1.108 – 9.032), p = 0.046) were factors associated with OS.

Conclusions : Although the outcome remains dismal, surgical resection remains an acceptable treatment modality.