A Case of Hepatocellular Carcinoma with Liver Cirrhosis Underwent Hepatectomy Four Times

Motoshi Yasui, Nobuhisa Ando, Hideki Nozaki, Michimasa Toyama, Susumu Kataoka, Masahiro Suenaga*

Department of Surgery, Meitetsu Hospital
*Department of Surgery, Nagoya Memorial Hospital

Recent progress in detecting early hepatocellular carcinoma (HCC) has increased the number of patients who undergo hepatectomy. The incidence of postoperative recurrence from a remnant, however, has also increased, and the prognosis may be altered by prophylactic measures. This is a report of a 55-year-old male patient who received three supplemental resections. Left hepatic lobectomy was carried out for liver-cirrhosis-complicated HCC extending over S₂ to S₄. About 15 months later, a second hepatic resection was performed for tumor recurrence in S₆. Seventeen months after the second resection, a third resection on S₇ and S₈ by thoracolaparotomy was performed, and a fourth resection on S₆ was carried out 10 months later. At present, 5 years and 7 months after the first hepatectomy, the patient is well without any symptoms of tumor recurrence. Thorough follow-ups by not only serum α-fetoprotein determination but also ultrasonography and computed tomography after the first operation are very necessary for those patients with liver cirrhosis as an underlying disorder, as there is a high incidence of tumor recurrence. Supplemental resection can be performed only when the liver function is comparatively unchanged from the function at the first operation, because extensive bleeding is expected in the process of denuding the sites of adherence. Therefore, careful denudation, and acquisition of a wide operative filed should be achieved. A transphrenic approach through thoracotomy, as in this case, is often useful.

Key words
hepatocellular carcinoma, liver cirrhosis, recurrence in the residual liver

Reprint requests
Motoshi Yasui Department of Surgery, Meitetsu Hospital
3-45 Matsumae-chou, Nishi-ku, Nagoya, 451 JAPAN

Accepted
February 13, 1991

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