SURGICAL-TREATMENT OF HCC IN CIRRHOTIC-PA TIENTS

In 1986, our institution published the first results of surgical resec tion of hepatocarcinoma in cirrhotic patients. The aim of this paper i s to present long term results of this surgical management. From April 1978 to February 1992, 74 patients were operated on at the surgical c linic of University Medical Center of Rennes (35000) France. There wer e 60 hepatectomies and 14 transplantations. The mean age was 60.2 year s +/- 9 years and the sex ratio : 70 males and 4 females. The etiology was alcoholic in 43 patients (58 %), post hepatitis (B and C) in 22 p atients (30 %) and due to hemochromatosis in 9 patients (12 %). Accord ing to the Child Pugh classification, 48 patients were Child A, 11 Chi ld B and one Child C in the hepatectomy group and 9 patients Child A a nd 5 Child B in transplantation group. The operative mortality was 10 % in hepatectomy group and 35,7 % in liver transplantation group. Over all survival was 61.8 % at 1 year, 47.1 % at 2 years, 38.2 % at 3 year s and 20 % at 5 years. 5 year survival is 21.4 % after transplantation and 18.5 % after resection. This difference is not significant. In co nclusion, according to 5 years survival and to operative mortality the treatment of choice is hepatectomy in HCC in cirrhotic patients. Howe ver the best treatment is the prevention of cirrhosis.