[Evaluation of hepatic resection for hepatocellular carcinoma on cirrhotic livers].
BACKGROUND
The hepatocellular carcinoma is a disorder that affects patients suffering from cirrhosis. Liver resection, orthotopic liver transplantation and percutaneous ablation are some forms of therapy currently used to provide a cure for this disease.


OBJECTIVE
To assess the results achieved through liver resection for the treatment of the hepatocellular carcinoma in patients with cirrhosis being under treatment in a general hospital.


METHODS
Clinical observation, laboratory test results, endoscopic and histopathologic analysis were taken into consideration in the case of 22 patients who underwent liver resection between 1996 and 2005. To verify the survival rates, identify the prognostic factors and determine the risk of recurrence, special attention was given to the serologic levels of bilirubins and alpha-fetoprotein, and to the level of the hepatocellular dysfunction (classified according to the Child-Pugh-Turcotte and the Model for End-Stage Liver Disease parameters). The size and number of tumours, microvascular invasion and the presence of satellite lesions were also taken into consideration. The level of statistic significance employed was of 95%.


RESULTS
In the cases studied, patients had an average age of 62.09 years, being 17 of them male. In 10 cases the liver cirrhosis was associated to the hepatitis C chronic infection; in 4 cases there was a combination of chronic ingestion of ethanol and the hepatitis C virus; in 3 cases there was an association with the hepatitis B virus chronic infection. Two cases were related to the chronic ingestion of ethanol alone and in one case the use of medications was reported. It was not possible to establish the etiology in two of the cases studied. Eighteen patients had a single tumour, 11 of them smaller than 5 cm. The survival rate varied between 10 days and 120 months, being of 33.5 months on average. At the end of the 1st, 3rd and 5th year, the survival rates were 61.90%, 16.67% and 11.11%, respectively. Three patients died within the first 3 months after the liver resection. Thirteen patients died after the first 3 months, 12 of the cases associated to tumour recurrence and tumour progression. There was one death in the immediate post-operative period of a second operation carried out to remove a recurrent tumour. When it comes to the survival rate and the identification of prognostic factors, a relationship between patients survival and microvascular invasion was observed. No statically significant relationship was established between the survival rate and the serologic levels of bilirubins and alpha-fetoprotein or the level of hepatocellular dysfunction, size or number of tumours. However, a more significant incidence of tumour recurrence was observed in patients with microvascular invasion in the histopathologic study.


CONCLUSIONS
In spite of the reduced number of cases studied, the surgical treatment of the hepatocellular carcinoma produced bad results. A careful selection of cases where surgery could be an option may be a decisive factor to improve such results. A careful selection of cases might be a decisive factor in order to improve such results.
Silva
Maurício
M
Transplante Hepático e Cirurgia Hepatobiliopancreática, Santa Casa de Porto Alegre, Porto Alegre, RS. mauriciosilva11@yahoo.com.br
Mattos
Angelo Alves de
AA
Fontes
Paulo Roberto Ott
PR
Waechter
Fábio Luiz
FL
Pereira-Lima
Luiz
L
D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
D000509:alpha-Fetoproteins; D001663:Bilirubin