A Study of Operative Procedure for Hepatocellular Carcinoma with Special Reference to the Type of Relative Hepatitis

Yoh Fukuda, Shiro Yogita, Seiki Tashiro, Masashi Ishikawa, Hidenori Miyake, Keiko Yagi, Takayuki Miyauchi, Masamitsu Harada

The First Department of Surgery, School of Medicine, The University of Tokushima

The operative outcome after hepatic resection for hepatocellular carcinoma (HCC) was examined in 91 patients, according to whether the underlying hepatitis type is B or C. Twenty-four patients positive for hepatitis B antigen (HBsAg)-(Group B), and 67 patients positive for hepatitis C antibody (HCVAb) (Group C) were compared. Group B patients were younger and had a larger tumor than the patients in Group C. Because of the higher incidence of portal vein involvement or intrahepatic metastasis in patients with tumors more than 5 cm in diameter, operative procedures and operative outcomes were examined in patients with a tumor smaller than 5 cm in diamter (n=81). Recurrence was observed in 4 out of 18 patients (22.2%) in Group B, and in 36 out of 63 patients (57.1%) in Group C. The patterns of recurrence were not similar in the two groups. Multiple recurrence in the residual liver was observed in 2 cases (50%) in Group B, while in Group C there were only five multiple recurrent cases (13.9%), and significant differences were not observed in the prevalence of recurrent sites in the liver. In conclusion, as Group B revealed a smaller decrease in liver funciton, and often recurrence from the primary tumor, systemic resection should be offered as far as possible in the initial operation. In contrast, in Group C, as synchronous or metachronous multicentric occurrence is dominant, limited resection according to Glisson structure should be performed.

Key words
hepatitis C, hepatitis B, limited resection, recurrence, hepatocellular carcinoma

Reprint requests
Yoh Fukuda Department of Surgeyr, Takamatsu City Hospital
2-36-1 Miyawaki-cho, Takamatsu, 760-0005 JAPAN

Accepted
July 22, 1998

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