ANALYSIS OF FACTORS AFFECTING OUTCOME AFTER HEPATECTOMY OF PATIENTS WITH LIVER-CIRRHOSIS AND SMALL HEPATOCELLULAR-CARCINOMA

Objective: To review our policy of screening patients at risk of devel oping hepatocellular carcinoma (HCC), and to present 10 years' experie nce of hepatic resection for small HCC (<5 cm). Design: Retrospective study. Setting: Teaching hospital, Germany. Subjects: 861 patients wit h hepatic cirrhosis and oesophageal varices of whom 151 (18%) had HCC confirmed histologically; 30 of these tumours (20%) were less that 5 c m in diameter and suitable for resection. Interventions: Segmentectomy (n = 14) bisegmentectomy (n = 10), and oncologically defined wedge re section (n = 6). Main outcome measures: Mortality, morbidity, and surv ival. Results: 4 patients died within 30 days of liver failure and sep sis (n = 2), liver failure (n = 1), and bronchopueumonia (n = 1). The main beneficial prognostic factors were Child classification, donation of autologous blood, and an encapsulated tumour. The main indicators of a poor prognosis were invasion of the Liver, venous invasion, invas ion of the resection margin, and the presence of microsatellite tumour s and nodules. 12 of the 26 survivors developed recurrences during the first five years postoperatively (46%). Kaplan-Meier survival curves showed that survival at 1 year was 80%, at 3 years 65%, and 5 years 50 %, and at 10 years 30%. Conclusion: Hepatic resection is a useful trea tment for small HCC, but its success depends on early detection and ca reful selection of patients.