Abstract
Background. The long-term outcome after resection of hepatocellular carcinoma (HCC) is influenced
by parameters related to the tumor and the underlying liver disease. However, the
extent of the resection, which can be limited or anatomical (including the tumor and
its portal territory), is controversial. Methods. Among 64 Child-Pugh A patients with cirrhosis who underwent curative liver resection
for small HCC (≤ 4 cm) between 1990 and 1996, 34 patients underwent limited resection
with a margin width of at least 1 cm, and 30 patients underwent anatomic resection
of at least 1 liver segment with complete removal of the portal area containing the
tumor. The 2 groups were comparable in terms of epidemiologic and pathologic parameters.
The major end points were: (1) in-hospital mortality and morbidity; (2) overall and
disease-free survival; and (3) rate and topography of recurrence. Results. The 30-day mortality (6% vs 7%) and morbidity (52% vs 47%) rates after limited and
anatomic liver resection were not statistically different. The 5- and 8-year overall
survival rates after limited versus anatomic resection were, respectively, 35% versus
54% (P <.05) and 6% versus 45% (P <.05). The 5- and 8-year disease-free survival rates were, respectively, 26% versus
45% and 0% versus 21% (P <.05). Local recurrence was more frequently observed after limited resections than
after anatomic resections (50% vs 10%, P <.05). Conclusions. In patients with cirrhosis and a small HCC, anatomic resection achieves better disease-free
survival than limited resection without increasing the postoperative risk. Therefore,
anatomical resection should be the treatment of choice and considered as the reference
surgical treatment compared with other treatments. (Surgery 2002;131:311-7.)
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Article info
Publication history
Accepted:
November 17,
2001
Footnotes
*Reprint requests: Jacques Belghiti, MD, Department of Hepatobiliary and Digestive Surgery, Beaujon Hospital, 92 118 Clichy Cédex, France.
Identification
Copyright
© 2002 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
