PREOPERATIVE CT VOLUMETRIC ANALYSIS TO PLAN LIVER RESECTION FOR HEPATOCELLULAR CARCINOMA ON CIRRHOSIS

The purpose of this study was to evaluate the influence of liver function and liver’s volumetric parameters on liver resection for hepatocellular carcinoma on cirrhosis. We used CT images in 66 consecutive patients, affected by HCC on cirrhosis, to evaluate the liver’s and tumor’s volume and to plan preoperatively the surgical procedure to perform, calculat- ing the estimated liver remnant volume (ELRV). The 50 (75.7%) patients belonged to Child-Pugh class A, 16 (24.3%) to class B and C. The areas of the liver, of the lesion, and of the planned resection were delineated consecutively on the screen: ELRV was calculated by subtraction of Total Liver Volume (TLV) and Resection Volume (RV). In-hospital mortality rate was 4.6%, 66% of these cases were Child-Pugh B patients, morbidity rate was 25.8%. The 1-, 3-, 5-, and 7-year survival rates for Child-Pugh class A vs. B C were 74.5%, 37.6%, 26.2%, 12.6% vs. 50%, 27.3%, 18.2%, and 6.5%, respectively (P 0.05). Analyzing results on the basis of %ELRV in Child-Pugh class A 1-, 3-, 5-, and 7-year survival rate of 72.5%, 50%, 29.2%, and 11.6% is reported when ELRV was over 50%, and 62.5%, 50%, 22.5%, and 0% when ELRV was under 50% (P n.s.). A 1-, 3-, 5-, and 7-year survival rate calculated for Child-Pugh class B C group was 54.5%, 36.4%, 27.3%, 16.3% vs. 25%, 0%, 0% and 0%, 50% vs. 50% ELRV, respectively (P 0.05). This study shows that the selection of patients with HCC on cirrhosis needs more than a techni- cal and oncological evaluation: the %ELRV could be a good preopera- tive parameter to plan the surgical procedure when it could be performed. In our series for Child-Pugh B C, an ELRV 50% is associated with high mortality in the first year and no survival after the third year compared with ELRV 50%, while the threshold of 50% ELRV is not so critical for Child-Pugh class A. Child-Pugh class combined with %ELRV could give the surgeon more information about the safely procedure to perform to obtain the more radical resection according to patient’s clinical condition