Selection of Scale of Hepatic Resection for Small Hepatocellular Carcinoma Evaluated on the Basis of Recurrences Examined Retrospectively

Taichi Shuto, Hiroaki Kinoshita, Kazuhiro Hirohashi, Shoji Kubo, Tadashi Tsukamoto, Toyokazu Okuda, Akishige Kanazawa, Shinichi Mikami, Chikaharu Sakata, Takashi Ikebe*

Second Department of Surgery and *Second Department of Pathology, Osaka City Univetsity Medical School

In our hospital, as of December 1993, radical hepatic resections had been performed in 82 patients with small hepatocellular carcinoma (HCC) 2 cm or smaller. Bisegmentectomy was done in 8 patients, segmentectomy in 11, subsegmentectomy in 20, and partial resection in 43. When the results of preoperative liver function tests were satisfactory, a large-scale operation was generally possible, but in decisions about the scale of the operation, the intraoperative appearance and findings from palpation of the liver were more important than preopeartive findings. There were recurences in 39 patients. The survival rate and tumor-free survival rate were better after bisegmentectomy than after smaller scale operations. If the scale of surgery had been decided according to preoperative liver function, 12 patients of the 74 who did not in fact undergo bisegmentectomy could have been selected for bisegmentectomy. However, in these 12 patients, only two had recurrences. If bisegmentectomy had been done for all patients, then of the 37 cases of recurrence among the 74 patients who did not undergo bisegmentectomy, seven could have been prevented (the recurrence was within the part of the liver that would have been resected). However, because of liver dysfunction, six of these seven patients could not have withstood bisegmentectomy. Our selection of the scale for resection of small HCC on the basis of results of liver function tests, intraoperative inspection, and palpation of the liver was suitable except for one patient.

Key words
small hepatocellular carcinoma, types of hepatic resection, surgical indication, recurrence after hepatic resection

Reprint requests
Taichi Shuto Second Department of Surgery, Osaka City University Medical School
1-5-7 Asahimachi, Abeno-ku, Osaka City, 545 JAPAN

Accepted
January 10, 1996

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