Prognostic factors after hepatic resection for hepatocellular carcinoma associated with Child-Turcotte class B and C cirrhosis

Objective To evaluate prognostic factors after resection of hepatocellular carcinoma (HCC) in patients with Child-Turcotte class B and C cirrhosis. Summary Background Data Although hepatic resection remains the mainstay in the treatment of HCC and can be performed with law morbidity and mortality rates in patients without cirrhosis, its role is poorly defined for patient s with severe cirrhosis. Methods From 1986 to 1996, partial hepatectomy was performed for HCC in 63 patients with Child-Turcotte class B (n = 46) and C (n = 17) cirrhosis, The re were 46 men and 17 women, with an average age of 61.2 years (range 35 to 79 years). Associated conditions were diabetes mellitus in 45, esophageal varices in 32, severe hypersplenism in 26, cholelithiasis in 13, gastroduod enal ulcer in 6, and hiatal hernia. gastric lymphoma, splenic abscess, and pancreatic cyst each in 1. Concomitant surgical procedures were performed f or most of these conditions. Results Major complications occurred in 17 patients (27%), six (9.5%) of wh om died within 1 month after surgery. The overall in-hospital death rate wa s 14.3%. Liver failure and intraabdominal sepsis were mostly fatal complica tions. The overall and disease-free survival rates, respectively, were 70.2 % and 64.5% at 1 year, 43.5% and 23.8% at 3 years, and 21.4% and 14.9% at 5 years. Multivariate analysis with the Cox regression model revealed that f avorable factors for survival were Child class B, no transcatheter arterial embolization before surgery, young age, and low alanine aminotransferase ( ALT) level before surgery. Conclusions Hepatic resection can provide a favorable result in young patie nts with HCC complicating Child class B cirrhosis with low hepatitis activi ty, but transcatheter arterial embolization before surgery should be avoide d in such patients.