Surgical treatment of hepatocellular carcinoma associated with spontaneousportosystemic shunts

Objective: To clarify the short and long term prognosis after hepatectomy a nd shunt ligation in patients with hepatocellular carcinoma (HCC) and spont aneous portosystemic (P-S) shunts. Design: Retrospective study. Setting: University hospital, Japan. Subjects: Fourteen patients with HCC and a P-S shunt. Interventions: Hepatic resection (radical in 12 and palliative in 2 patient s) and ligation of the shunt; 12 also had prophylactic operations for oesop hagogastric varices. Main outcome measures: Morbidity, mortality, hepatic function, and survival . Results: Serum ammonia concentrations fell after operation and stayed low t hroughout the postoperative period. Though prothrombin time and serum antit hrombin-III concentrations deteriorated for one month after operation, they gradually returned to the preoperative values. Serum albumin did not chang e throughout the follow up period. Serum bilirubin concentrations were redu ced postoperatively in 10 patients. Results of indocyanine green and Bromsu lphalein retention tests were similar before and one month after operation. Child's grade improved in four patients within a year. At 1, 3, and 5 year s 10, 5, and 3 patients were alive, and 10, 4, and 1 of these were free of disease. No patients ruptured their oesophagogastric varices during the fol low up period. Conclusions: Simultaneous ligation of spontaneous P-S shunts makes hepatic resection safe and produces unexpectedly good survival in patients with HCC and the severe cirrhosis associated with such shunts.