Evaluation of major hepatic resection for small hepatocellular carcinoma.
OBJECTIVE
The aim of this study is to clarify the significance of a major hepatectomy for small hepatocellular carcinomas (HCCs).


METHODS
Seventy-eight patients with solitary HCC measuring less than 3 cm in diameter, whose liver function was considered sufficient to tolerate a right hepatic lobectomy, were classified into 2 groups consisting of: a major group (n = 18), who underwent a major hepatectomy (2 segments or more); and, a minor group (n = 60), who underwent a hepatectomy including one segment or less. The early post-operative outcome and the long-term outcomes, comprising patient survival as well as disease-free survival, were compared. In addition, the post-operative long-term changes in liver function tests and esophageal variceal occurrence were also compared.


RESULTS
In the post-operative mortality and morbidity, no significant differences were found between the 2 groups. However, 1 patient in the major group unexpectedly died of liver failure 6 months after operation. No significant difference was observed in patient survival and disease-free survival. The platelet count in the major group tended to decline more rapidly than that in the minor group. Furthermore, 1 patient in the major group demonstrated risky esophageal varices 29 months after operation, which had to be treated by endoscopic injection sclerotherapy.


CONCLUSIONS
Based on the above findings, a major hepatectomy is therefore not recommended for patients with solitary small HCC measuring 3 cm or less in diameter.
Shimada
M
M
Second Department of Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan. mshimada@surg2.med.kyushu-u.ac.jp
Gion
T
T
Hamatsu
T
T
Yamashita
Y
Y
Hasegawa
H
H
Utsunomiya
T
T
Takenaka
K
K
Sugimachi
K
K
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome