Abstract
One hundred and eighteen patients underwent hepatic resection for hepatocellular carcinoma from 1979 to 1987. Ninety-eight of these patients had co-existing cirrhosis of the liver; 18 patients underwent lobectomy, 28 patients had segmentectomy, and 52 patients had subsegmentectomy. In the 21 non-cirrhotic patients, 11 patients underwent lobectomy, 5 patients had segmentectomy, and 5 patients had subsegmentectomy. The operative mortality rate of patients with cirrhosis was 11% and of patients without cirrhosis was 5%. There was no significant difference in hepatic function tests between survivors and nonsurvivors. Lobectomy of <55% of the parenchymal hepatic resection rate was well tolerated in the patients with cirrhosis. One-year, 3-year, and 5-year survival rates of patients with hepatocellular carcinoma and co-existing cirrhosis were 57.9%, 36.8% and 20.0% following lobectomy, 82.8%, 82.8% and 57.6% following segmentectomy, and 72.0%, 46.2% and 24.0% following subsegmentectomy. The tumor recurrence rate appeared to be lower after segmentectomy than subsegmentectomy. Multiple gross lesions, tumors >5 cm, and presence of gross vascular invasion were poor prognostic signs in terms of survival rates as well as recurrence rates. Of the 51 patients with tumor recurrence limited to the residual liver, 13 patients underwent repeat resection, and 23 patients were treated by transcatheter arterial chemoembolization. The survival rates of the patients undergoing repeat resection were significantly better than those of other groups.
Résumé
Cent dix huit résections hépatiques pour carcinome hépatocellulaire ont été réalisées entre 1979 et 1987. Quatre vingt dix huit de ces patients étaient cirrhotiques et 18 d'entre eux ont eu une lobectomie, 28 une segmentectomie et 52 une sous-segmentectomie. Chez les 21 patients non cirrhotiques, il y a eu 11 lobectomies, 5 segmentectomies et 5 sous-segmentectomies. La mortalité des patients cirrhotiques et non cirrhotiques était respectivement de 11% et de 5%. Il n'y avait pas de différence significative entre les tests hépatiques des patients survivants et de ceux qui mourraient; cependant, une lobectomie limitée à moins de 55% du parenchyme hépatique était mieux supportée par le patient cirrhotique. La survie à un, trois, cinq ans des patients cirrhotiques était respectivement de 57.9, 36.8 et 20.0% après lobectomie, de 82.8, 82.8 et 57.6% après segmentectomie et de 72.0, 46.2 et 24.0% après sous-segmentectomie. La récidive tumorale était moins fréquente après segmentectomie qu'après sous-segmentectomie. Des lésions multiples, des lésions de plus de 5 cm de diamètre et des signes d'envahissement vasculaire étaient des signes de mauvais pronostic, associés à une récidive. Sur les 51 récidives tumorales au sein du parenchyme restant, 13 ont pu être l'objet de résection alors que 23 ont été traitées par chimio-embolisation intra-artérielle. La survive des patients ayant eu des résections itératives était meilleure que celle des autres patients et ce de façon significative.
Resumen
Se practicaron 118 resecciones hepáticas por carcinoma hepatocellular entre 1979 y 1987. En 98 casos se encontró cirrosis hepática coexistente: 18 pacientes fueron sometidos a lobectomía, 28 a segmentectomía y 52 a subsegmentectomía. En cuanto a los 21 pacientes no cirróticos, 11 fueron sometidos a lobectomía, 5 a segmentectomía y 5 a subsegmentectomía. La tasa de mortalidad operatoria de los pacientes cirróticos fue 11% y la de los no cirróticos 5%. No se observó differencia significativa en las pruebas de función hepática entre los sobrevivientes y los no sobrevivientes, pero la lobectomía de menos del 55% del parenquima hepático resultó ser bien tolerada por los pacientes con cirrosis. Las tasas de sobrevida a uno, tres y cinco años de los cirróticos fueron de 57.9%, 36.8% y 20.0% después de lobectomía, 82.8%, 82.8% y 57.6% después de segmentectomía y 72.0%, 46.2% y 24.0% después de subsegmentectomía. La tasa de recurrencia tumoral resultó ser menor después de segmentectomía que de subsegmentectomía. La presencia de lesiones múltiples grandes, de tumores mayores de 5 cm y la invasión vascular macroscópica demostraron ser signos de mal pronóstico en términos de las tasas de sobrevida así como de las tasas de recurrencia. De las 51 recurrencias tumorales limitadas al hígado residual, 13 fueron resecadas y 23 fueron tratadas mediante quimioembolización transarterial (catéter). Las tasas de sobrevida de los pacientes sometidos a re-resección fueron significativamente mejores que las de los otros grupos.
Similar content being viewed by others
References
Starzl, T.E., Koep, L.J., Weil, R. III, Lilly, J.R., Putnam, C.W. Aldrete, A.J.: Right trisegmentectomy for hepatic neoplasms. Surg. Gynecol. Obstet.150:208, 1980
Iwatsuki, S., Shaw, B.W. Jr., Starzl, T.E.: Experience with 150 liver resections. Ann. Surg.197:247, 1983
Fortner, G.F., Kim, D.K., Maclean, B.J., Barrett, M.K., Iwatsuki, S., Turnbull, A.D., Howland, W.S., Beattie, E.J.: Major hepatic resection for neoplasms: Personal experience in 108 patients. Ann. Surg.188:375, 1978
Thompson, H.H., Tompkins, R.K., Longmire, W.P.: Major hepatic resection: A 25-year experience. Ann. Surg.197:375, 1983
Okuda, K., and the Liver Cancer Study Group of Japan: Primary liver cancers in Japan. Cancer45:2663, 1980
The Liver Cancer Study Group of Japan: Primary liver cancer of Japan. Cancer54:1747, 1984
Shikata, T.: Primary cancer and liver cirrhosis. In Hepatocellular carcinoma, K. Okuda, R.L. Peters, editors, New York, John Wiley & Sons, 1975, pp. 53–71
Okamoto, E., Kyo, A., Yamanaka, N., Tanaka, N., Kuwata, K.: Prediction of the safe limits of hepatectomy by combined volumetric and functional measurements in patients with impaired hepatic function. Surgery95:586, 1984
Kanematsu, T., Takenaka, K., Matsumata, T., Furuta, T., Sugimachi, K., Inokuchi, K.: Limited hepatic resection effective for selected cirrhotic patients with primary liver cancer. Ann. Surg.199:51, 1984
Nagasue, N., Yukaya, H., Ogawa, Y., Sasaki, Y., Chang, Y.-C., Niimi, K.: Clinical experience with 118 hepatic resections for hepatocellular carcinoma. Surgery99:694, 1986
Yamanaka, N., Okamoto, E., Kuwata, K., Tanaka, N.: A multiple regression equation for prediction of posthepatectomy liver failure. Ann. Surg.200:658, 1984
Mondy, F.G., Rikkers, L.F., Aldlete, J.S.: Estimation of functional reserve of human liver. Ann. Surg.180:592, 1974
Couinaud, C.: Lobes et segments hepatiques Notes sur larchitecture anatomique et chirurgical du fole. La presse Medicale62:709, 1954
Makuuchi, M., Hasegawa, H., Yamazaki, S.: Ultrasonically guided subsegmentectomy. Surg. Gynecol. Obstet.101:346, 1985
Healey, J.E.: Clinical anatomic aspects of radical hepatic surgery. J. Int. Coll. Surgeons22:542, 1954
Takasaki, K., Kobayashi, S.: Subsegmentectomy and small lot of resection by Grisson sheath binding method. Geka Shinryo (Japanese)28:349, 1987
Tabuse, K., Katsumi, M., Kobayashi, Y., Noguchi, H., Egawa, H., Aoyama, O., Kim H. Nagai, Y., Yamaue, H., Mori, K., Azuma, Y., Tsuji, T.: Microwave surgery: Hepatectomy using a microwave tissue coagulator. World J. Surg6:360, 1982
Wheeler, P. G., Mella, W., Dubbins, P., Jones, B., Nunnerley, H., Johnson, P., Williams, R.: Nonoperative arterial embolization in primary liver tumors. Br. Med. J.2:242, 1979
Yamada, R., Sato, M., Kawabata, M., Nakatsuka, H., Nakamura, K., Takashima, S.: Hepatic artery embolization in 120 patients with unresectable hepatoma. Interventional Radiology.148:397, 1983
Lin, T.Y., Lee, C.S., Chen, K.M., Chen, C.C.: Role of surgery in the treatment of primary carcinoma of the liver: A 31-year experience. Br. J. Surg.74:839, 1987
Lee, N.W., Wong, J., Ong, G.B.: The surgical management of primary carcinoma of the liver. World J. Surg.6:66, 1982
Tsuzuki, T., Sugioka, A., Ueda, M., Iida, S., Kanai, T., Yoshii, H., Nakayasu, K.: Hepatic resection for hepatocellular carcinoma. Surgery107:511, 1990
Nagao, T., Goto, S., Kawano, N., Inoue, S., Mizuta, T., Morioka, Y., Omori, Y.: Hepatic resection for hepatocellular carcinoma. Ann. Surg.205:33, 1987
Mizumoto, R., Kawarada, Y., Noguchi, T.: Preoperative estimation of operative risk in liver surgery, with special reference to functional reserve of the remnant liver following major hepatic resection. Jpn. J. Surg.9:343, 1979
Okamoto, E., Tanaka, N., Yamanaka, N., Toyosaka, A.: Results of surgical treatments of primary hepatocellular carcinoma: Some aspect to improve long-term survival. World J. Surg.8:360, 1984
Okazaki, N.: Systemic chemotherapy of hepatocellular carcinoma. In Hepatocellular Carcinoma, K. Okuda, R. L. Peters, editors, New York, John Wiley & Sons, 1975, pp. 469–475
Iwatsuki, S., Gordon, R.D., Shaw, B.W. Jr., Starzl, T.E.: Role of liver transplantation in cancer therapy. Ann. Surg.202:401, 1985
Pichlmayr, R.: Is there a place for liver grafting for malignancy? Transplant. Proc.20(suppl):478, 1988
O'Grady, J.G., Polson, R.J., Rolles, K., Calne, R.Y., Williams, R.: Liver transplantation for malignant disease: Results in 93 consecutive patients. Ann. Surg.207:373, 1988
Livrghi, T., Festi, D., Monti, F., Salmi, A., Vittori, C.: US-guided percutaneous alcohol injection of small hepatic and abdominal tumors. Radiology310:309, 1986
Alpert, E.A.: Human alpha-1 fetoprotein. In Hepatocellular Carcinoma. K. Okuda, R. L. Peters, editors, New York, John Wiley & Sons, 1975, pp. 353–367
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Suenaga, M., Nakao, A., Harada, A. et al. Hepatic resection for hepatocellular carcinoma. World J. Surg. 16, 97–104 (1992). https://doi.org/10.1007/BF02067120
Issue Date:
DOI: https://doi.org/10.1007/BF02067120