Small unilocular hepatocellular carcinoma in cirrhotic patients. Early diagnosis, surgical indication, resection and prognosis

In 151 (17.5 %) of 861 patients with liver cirrhosis regularly screened by sonography and determination of a-fetoprotein a hepatocellular carcinoma (H CC) was detected. Diagnosis was verified by sonographically guided fine nee dle puncture and exceptionally by laparoscopy and direct puncture. In 34 pa tients (22.5 %) selection criteria for operation were a tumour diameter und er 5 cm, no central localisation in the liver and at least 5 mm distant fro m the main structures; furthermore multilocular HCC and intra- and extrahep atic metastases were contraindications. Additionally Child-Pugh-classificat ion should be A + B and urea synthesis rate 6 g per day. 27 patients (80 %) had esophagogastric varices seen at endoscopy and 20 (59 %) had bleeding e pisodes from varices managed endoscopically or surgically. Types of surgica l resections were segmentectomy [17], bisegmentectomy [10] and oncologicall y defined wedge resections [7] using controlled hypotension and interrupted occlusion of the hepatoduodenal ligament. 4 patients (11.8 %) died within 30 days of liver failure [3] and sepsis [1]. All patients could be followed up for eleven years: 18 patients died after 1.5-10 years of liver failure, tumour recurrence or second tumour and a cause not associated with HCC, 12 patients are living. Kaplan-Meier survival curves show that survival at 5 years is 50 % and at 10 years 34 %. The main indicators for a good prognosi s were clinically the HBsAG-activity, the Child-Pugh-classification and the application of autologous blood, pathologic-anatomically the classificatio n and grading and histologically the absence of vascular invasion, absence of satellites and a number of mitoses under 7 in the visual field. For tumo ur recurrence dysplasia is of positive influence. - Liver resection remains the most widely used therapeutic option for treatment of HCC in cirrhosis; The early and long-term results can be improved by early diagnosis, strict selection of patients for operation and the use of well defined clinical, pathological and histological criteria.