Comparison of limited and anatomic hepatic resection for hepatocellular carcinoma with hepatitis C.
BACKGROUND
The long-term outcome after resection of hepatocellular carcinoma is influenced by factors related to the tumor and the underlying liver disease. The prognosis of hepatocellular carcinoma is worse in hepatitis C virus antibody-positive patients than in hepatitis B surface antigen-positive patients. In patients with hepatitis C virus infection and hepatocellular carcinoma, the optimum extent of operative resection, i.e., limited versus anatomic, remains controversial.


METHODS
Among 247 patients with hepatitis C virus infection who underwent curative resection of hepatocellular carcinoma between 1992 and 2003, 213 patients received limited resection and 34 patients had anatomic resection of at least two Couinaud subsegments with complete removal of the portal territory containing the tumor. The clinical characteristics, operative results, and long-term survival of these two groups were compared.


RESULTS
Although the patients receiving limited resection had significantly worse preoperative liver function than the patients undergoing anatomic resection, the postoperative liver function of the limited resection group was significantly better. The mortality and morbidity rates were not significantly different after limited and anatomic resection. Disease-free survival and overall survival were similar after both types of resection, as were the incidence and pattern of intrahepatic tumor recurrence.


CONCLUSIONS
In patients with hepatitis C virus infection and hepatocellular carcinoma, anatomic resection does not provide any significant benefit and should not be carried out unless it is technically necessary. In patients with a limited hepatic functional reserve, removal of the tumor with preservation of the liver parenchyma may take priority over wide resection.
Kaibori
Masaki
M
Department of Surgery, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka 570-8507, Japan. kaibori@takii.kmu.ac.jp
Matsui
Yoichi
Y
Hijikawa
Takeshi
T
Uchida
Yoichiro
Y
Kwon
A-Hon
AH
Kamiyama
Yasuo
Y
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery* / Q000821:virology*; D015897:Comorbidity; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008099:Liver / Q000502:physiology; D008113:Liver Neoplasms / Q000601:surgery* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome