Effectiveness of Anatomical Subsegmentectomy of the Liver Under Selective Portal Inflow Occlusion in Patients with Hepatocellular Carcinoma Limited to a Subsegment

Ichiro Makino, Kazuo Chijiiwa, Kazuhiro Kondo, Yoshiyuki Kunieda, Motoharu Nagano, Masahide Hiyoshi, Jiro Ohuchida and Masahiro Kai

Department of Surgery 1, Miyazaki University School of Medicine

Purpose: To clarify whether differences in type of hepatic resection and hepatic inflow occlusion affect the outcome of patients with hepatocellular carcinoma (HCC) limited to one subsegment (Hs-HCC). Method: Thirty-seven Hs-HCC patients who had undergone curative hepatectomy were divided into two groups based on the type of resection: a group that underwent anatomical subsegmentectomy (HrS) (n=26) and a group that underwent non-anatomical limited resection (Hr0) (n=11). The patients in the HrS group were divided into two groups according to the type of hepatic inflow occlusion during hepatic resection: a total inflow occlusion (TPVO) group (n=16) and a selective inflow occlusion (SPVO) group (n=10), and clinicopathologic and tumor-related factors were compared between the groups. Moreover, factors affecting recurrence-free survival were examined by univariate followed by multivariate analyses. Postoperative survival and disease-free survival were compared between the HrS group and the Hr0 group and between the TPVO group and the SPVO group. Results: The clinicopathologic background in the HrS and Hr0 groups was essentially similar except for age. Tumor size was the only tumor-related factor that was significantly greater in the HrS group than in the Hr0 group. There were no significant differences in either clinicopathologic or tumor-related factors between the TPVO group and the SPVO group. The postoperative survival and disease-free survival were better in the HrS group than in the Hr0 group, however, the difference did not reach the level of statistical significance. The postoperative survival and disease-free survival in the SPVO group were significantly better than those in the TPVO group. The PV invasion was significant factor for recurrence-free survival by the multivariate analysis (p=0.042). The type of PV occlusion was a significant factor for recurrence-free survival by univariate analysis (p<0.02) but did not reach the level of statistical significance by multivariate analysis. Conclusion: Anatomical subsegmentectomy under selective portal inflow occlusion is concluded to be a method of treatment that improves the outcome of the patients with Hs-HCC.

Key words
hepatocellular carcinoma, hepatic resection, selective portal inflow occlusion, long-term outcome

Reprint requests
Kazuo Chijiiwa Department of Surgery 1, Miyazaki University School of Medicine
5200 Kihara, Kiyotake-cho, Miyazaki-gun, 889-1692 JAPAN

Accepted
March 30, 2005

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