Effectiveness of systematized hepatectomy with Glisson's pedicle transection at the hepatic hilus for small nodular hepatocellular carcinoma: Retrospective analysis

Background. The effectiveness of systematized hepatectomy with transection of Glisson's pedicle at the hepatic hilus in patients with small nodular he patocellular carcinoma (HCC) has not been confirmed. Methods. Surgical outcomes were reviewed in 204 patients with single nodula r HCCs less than 5 cm in greatest diameter, including 68 patients with tumo rs that showed extranodular growth and 136 patients with tumors that did no t, who had undergone curative hepatectomy (Partial hepatic resection, n = 1 14; systematized hepatectomy, n = 90)from 1990 through 1994. Results. The rates of microscopic vascular invasion and intrahepatic metast asis were significantly higher in patients who had single nodular HCCs with extranodular growth (34 % and 49 %) than in Patients who had single nodula r HCCs without extranodular growth (13 %, P = .001, and 4 %, P < .001). The 5-year survival rate in patients who had single nodular HCCs with extranod ular growth was signiflicantly, greater after systematized hepatectomy (67 %) than after partial hepatic resection (21 %, P = .000). Multivariate anal ysis showed that the type of operation was an independent prognostic factor in patients with single nodular HCCs with extranodular growth (P = .0008). Conclusions. Systematized hepatectomy with Glisson's pedicle transection at the hepatic hilus should be performed in patients who have single small no dular HCCs with extranodular growth because these tumors often invade withi n the liver sector containing the tumor.