LIVER RESECTION IN HEPATOCELLULAR CARCINOMA: OUTCOME, LONG-TERM RESULTS, AND PROGNOSTIC FACTORS

The purpose of this study, based on data prospectively collected, was to evaluate prognostic factors that influence outcome and long-term survival of liver resection for HCC. From September 1989 to March 2004, 124 consecutive patients had liver resection for HCC at our department. 94 patients belonged to Child-Pugh class A, 26 (20.9%) to class B. and 4 to class C. (3.2%). We performed 53 major liver resections (right hepatectomy, left hepatectomy, trisegmentectomy) and 71 limited resections (segmentectomy, wedge). In-hospital mortal- ity rate was 8.1%, morbidity rate was 48.3%, caused by the rising ofascites (10%), hepatic insufficiency (19%), biliary fistula (6%), hepatic abscess (25%), hemoperitoneum (10%) and pleural effusion (30%). At preoperative evaluation 81 lesions were unifocal, tumor size measured before resection was over 5 cm in 61% of the cases. The preservation of 1 cm or greater tumor free margins has obtained in 77% of cases, and the histopathological examination revealed the presence of a capsule in 68.5% of lesions. Cumulative 1-, 3-, 5-, and 7-year survival rate were 73.7%, 44.2%, 22.8%, and 12.9%. The prognostic factors correlated with overall survival were lesion diameter (5 cm vs. 5 cm, P 0.01), number of lesions (1 vs. 1, P 0.01), the presence of a capsule (P 0.05), Child-Pugh class (A vs. B. and C, P 0.05), Pringle’s maneuver time (20’ vs. 20’, P 0.05), type of resection (limited vs. major, P 0.05), postoperative complications (P 0.05), Oka- moto-Child Index (20% vs. 20%, P 0.01), and relapse of HCC (P 0.05). Liver resection is still the best practice against hepatocellular carcinoma. Surgical procedure should be encouraged in case of single lesion, diameter 5 cm, in patients of Child-Pugh class A, when the lesion is encapsulated and the surgical procedure could be limited rather than major Figure 1 shows cumulative survival: the influence of lesion’s diameter on survival, and Figure 2 shows cumulative sur- vival: the influence of postoperative complications on survival.