Factors affecting survival and long-term outcome in the cirrhotic patient undergoing hepatic resection for hepatocellular carcinoma

Aims: Prognostic analysis of hepatocellular carcinoma (HCC) in the cirrhoti c patient undergoing hepatic resection is necessary in order to determine t he clinical effect of hepatectomy on prognosis. Patients and methods: Univariate and multivariate retrospective analyses we re performed in 51 cirrhotic patients (38 men, 13 women; mean age 65 years, range 43-81 years) with supervening HCC undergoing hepatic resection betwe en January 1993 and December 1997. Results: Segmental liver resection was performed in 39 patients (76%) with non-anatomical (wedge) resections in the remainder of cases;The post-operat ive mortality rate was 8%. The tumours recurred in 23 patients (45%), with 12 patients (52% of recurrences) recurring within 1 year of surgery and 22 patients (96% of recurrences) within 3 years. Recurrent disease was most fr equently intrahepatic (22 patients). Significant risk factors for recurrenc e were micro/ macro vascular invasion, and symptoms. Conclusions: The recurrence rate of hepatocellular carcinoma in patients wi th cirrhosis undergoing surgical resection alone is high and actuarial surv ival at 4 years is low. Other approaches to the treatment of hepatocellular carcinoma in patients with cirrhosis require consideration. (C) 2000 Harco urt Publishers Ltd.