Hepatic resection for hepatocellular carcinoma.

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.