SINGULAR HEPATOCELLULAR-CARCINOMA IN LIVE R-CIRRHOSIS - EARLY DIAGNOSIS AND SURGICAL REMOVAL

721 patients with liver cirrhosis were regularly screened by sonograph y and determination of alpha fetoprotein during a period of eleven yea rs (1.1. 1982-1.1. 1993). In 137 of them hepatocellular carcinoma (HCC ) was diagnosed; 28 (20.4 %) had a unilocular HCC with a diameter up t o 5 cm. Diagnosis was regularly verified by sonographic guided punctur e, in rare cases by laparoscopy and biopsy. Beside a diameter of 5 cm the tumor should be localized at least 5 mm from the main structures i n the hilus, and not in the centre of the liver; furthermore multilocu lar hepatocellular carcinomas and intra- and extrahepatic metastases w ere contraindications. Child-Pugh-classification should be A + B and u rea synthesis rate at least 6 g per day. In 21 patients (75 %) a porta l hypertension was diagnosed; 19 (68 %) had bled from esophageal varic es; in case of one bleeding a therapeutic sclerotherapy and in case of recurrent variceal hemorrhage an elective shunt operation were perfor med. Surgical resection was carried out with controlled hypotension an d temporary occlusion of the hepatoduodenal ligament. Tumor was remove d by segmentectomy or bisegmentectomy and in rare cases by enucleation . There were 3 clinical deaths (10.7 %); causes of death were liver fa ilure and (2) sepsis (1). All patients could be followed up to January 1, 1993; there were 12 further deaths of liver failure, tumor recurre nce or second tumor. 13 patients are still living. Thus the live expec tancy for one year was 80, for 5 years 50 and for 10 years 30 %. There is no doubt, that it is possible to detect hepatocellular carcinoma i n patients with liver cirrhosis early by regular sonography and determ ination of alpha-fetoprotein. If there is an unilocular tumor not larg er than 5 cm in diameter the surgical resection should be performed. S urgical therapy can be performed with low risk and a hospital mortalit y of 10 %. Live expectancy for one year is 80, for 5 years 50 % and fo r 10 years 30 % and thus much better than in the majority of other gas trointestinal carcinomas.