HEPATIC SEGMENTECTOMY FOR CURATIVE RESECTION OF PRIMARY HEPATOCELLULAR-CARCINOMA

Objectives: To evaluate the feasibility and results of segmentectomy f or curative resection of hepatocellular carcinoma and to compare the c linicopathological findings of the patients according to the tumor loc ation in the liver. Design: Case series. Setting: A tertiary care cent er. Patients: Seventy-live patients with Child's grade A or B liver fu nction who had hepatocellular carcinoma that was confined to one segme nt and who underwent segmentectomy for curative resection of the tumor . The patients were divided into four groups: group P (posterior segme ntectomy, n=23); group A (anterior segmentectomy, n=10); group M (medi al segmentectomy, n=16); and group L (lateral segmentectomy, n=26). Ma in Outcome Measure: Disease-free survival rate. Results: Seventy-three percent of the the patients had cirrhosis of the liver. The surgical mortality and morbidity rates were 5.3% and 36.0%, respectively. The 1 -, 3-, and 5-year disease-free survival rates were 61.9%, 39.1%, and 2 6.3%, respectively, and were not significantly different among the fou r groups (P=.86). Group L had the least operative blood loss and short est operative time when compared with the other three groups (P<.05). The postoperative liver function changes were mild and transient in th e four groups of patients. With regard to pathological factors, only t umor size differed among the groups (tumors in group L were significan tly larger than those in the other three groups, P<.05). Forty-three p ercent of the recurrent tumors were solitary in the early stage, with 81% involving the segment(s) adjacent to the resected one and 57% bein g confined solely to the segment adjacent to the resected segment. Pat ients having recurrent hepatocellular carcinomas had significantly lar ger tumors at the time of resection than did those without recurrence (P=.03). Conclusions: Hepatic segmentectomy is an effective therapeuti c approach for small hepatocellular carcinomas and can be done safely even in patients with chronic liver disease and impaired liver functio n.