No-mortality liver resection for hepatocellular carcinoma in cirrhotic andnoncirrhotic patients - Is there a way? A prospective analysis of our approach

Background: Low resectability rates and significant morbidity and mortality rates often make surgery for hepatocellular carcinomas (HCCs) unfeasible. Hypothesis: Our policy for surgical treatment of cirrhotic and noncirrhotic patients with HCC is adequate and safe. Design: Prospective validation cohort study. Setting: University) hospital. Patients: One hundred seven consecutive patients with HCCs. Associated cirr hosis was present in 64 (59.8%), and only 7 (6.5%) had normal livers. Interventions: The presence of ascites, serum bilirubin level, and indocyan ine green retention rate at 15 minutes were considered when selecting patie nts for surgery. Preoperative recovery of liver function was achieved with portal venous branch embolization, liver volumetry, bed rest, and control o f serum aminotransferase levels. The surgical techniques mainly involved bl oodless dissection using intraoperative ultrasonography and intermittent wa rm ischemia. The main perioperative care regimen was fresh frozen plasma in fusion and strict limitation of blood transfusion. Main Outcome Measures The 30-day postoperative mortality and morbidity rate s. Results: All the patients underwent surgery (37 major resections, 45 segmen tectomies, and 25 limited resections), with no 30-day postoperative mortali ty, overall morbidity of 26.2%, and no major complications. Multiple logist ic regression analysis revealed that only the type of operation was associa ted with a significantly higher morbidity risk (P =.05). Conclusion: with high resectability, low morbidity, and no mortality, our p olicy represents a solution to the drawbacks of surgical resection for trea tment of HCCs, especially in patients with associated liver cirrhosis.