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  • Title: Perioperative and long-term outcome of major hepatic resection for small solitary hepatocellular carcinoma in patients with cirrhosis.
    Author: Lang BH, Poon RT, Fan ST, Wong J.
    Journal: Arch Surg; 2003 Nov; 138(11):1207-13. PubMed ID: 14609868.
    Abstract:
    HYPOTHESIS: Major hepatic resection is safe and provides favorable long-term survival for cirrhotic patients with a small solitary hepatocellular carcinoma. DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: 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). MAJOR OUTCOME MEASURES: 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. CONCLUSION: 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.
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