Surgical therapy of hepatocellular carcinoma in the cirrhotic liver.

Hepatectomy for hepatocellular carcinoma (HCC) associated with cirrhosis was considered by some surgeons contraindicated because the hospital mortality rate, especially for major hepatectomy, was very high. The author reported his surgical approach to hepatectomy associated with cirrhosis. Between 1989 and 1995, 66 major hepatectomies and 32 minor hepatectomies were performed in 98 cirrhotic patients. The selection of patients for hepatectomy was based on results of indocyanine green clearance test. The surgical technique was designed to reduce blood loss, ischaemic injury to the liver remnant and preservation of liver parenchyma. The postoperative care was designed to maintain or improve liver function. By such an approach, the hospital mortality rate of the cirrhotic patients having hepatectomy decreased from 40% in 1989 to 5% in 1995. The 5-year survival rate also improved to 41.2%, which is not statistically different from that of those with a normal liver or chronic hepatitis. With refinement in surgical technique and perioperative care, patients with cirrhosis can also benefit from hepatectomy for HCC.