Evaluation of major hepatic resection for small hepatocellular carcinoma

BACKGROUND/AIMS: The aim of this study is to clarify the significance of a major hepatectomy for small hepatocellular carcinomas (HCCs). METHODOLOGY: Seventy-eight patients with solitary HCC measuring less than 3 cm in diameter, whose liver function was considered sufficient to tolerate a right hepatic lobectomy, were classified into 2 groups consisting of: a m ajor group (n=18), who underwent a major hepatectomy (2 segments or more); and, a minor group (n=60), who underwent a hepatectomy including one segmen t or less. The early post-operative outcome and the long-term outcomes, com prising patient survival as well as disease-free survival, were compared. I n addition, the post-operative long-term changes in liver function tests an d esophageal variceal occurrence were also compared. RESULTS: In the post-operative mortality and morbidity, no significant diff erences were found between the 2 groups. However, 1 patient in the major gr oup unexpectedly died of liver failure 6 months after operation. No signifi cant difference was observed in patient survival and disease-free survival. The platelet count in the major group tended to decline more rapidly than that in the minor group. Furthermore, 1 patient in the major group demonstr ated risky esophageal varices 29 months after operation, which had to be tr eated by endoscopic injection sclerotherapy. CONCLUSIONS: Based on the above findings, a major hepatectomy is therefore not recommended for patients with solitary small HCC measuring 3cm or less in diameter.