Perioperative and long-term outcome of major hepatic resection for small solitary hepatocellular carcinoma in patients with cirrhosis.
OBJECTIVE
Major hepatic resection is safe and provides favorable long-term survival for cirrhotic patients with a small solitary hepatocellular carcinoma.


METHODS
Retrospective case series.


METHODS
Tertiary referral center.


METHODS
From January 1, 1989, to December 31, 2001, 218 cirrhotic patients with a solitary hepatocellular carcinoma 5 cm or less in diameter underwent either a major hepatic resection (n = 84) or a minor hepatic resection (n = 134).


METHODS
Perioperative morbidity and mortality, and long-term survival rates.


RESULTS
The major resection group had significantly larger tumors (median, 3.5 vs 2.5 cm; P<.001) and better liver function (median indocyanine green retention at 15 minutes, 9.3% vs 12.9%; P<.001) than the minor resection group. Postoperative morbidity (46.4% vs 39.6%) and mortality (8.3% vs 3.0%) were higher in the major resection group than in the minor resection group, but the differences did not reach statistical significance (P =.32 and P =.11, respectively). The median overall survival did not differ significantly between the 2 groups (102.0 vs 72.3 months; P =.25). However, the median disease-free survival in the major resection group was significantly better than that in the minor resection group (59.0 vs 29.5 months; P =.03). On further subgroup analysis, both disease-free and overall survival rates were significantly better in the major hepatic resection group for tumors of 3 to 5 cm.


CONCLUSIONS
In well-selected cirrhotic patients with a small, solitary hepatocellular carcinoma, major hepatic resection is safe and may offer a better long-term survival over minor hepatic resection for patients with tumors of 3 to 5 cm.
Lang
Brian Hung-Hin
BH
Centre for the Study of Liver Disease and Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
Poon
Ronnie Tung-Ping
RT
Fan
Sheung-Tat
ST
Wong
John
J
D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D002648:Child; D005260:Female; D006498:Hepatectomy / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data; D016896:Treatment Outcome