Is resection for large hepatocellular carcinoma in cirrhotic patients beneficial? Study of 38 cases

Background/Aims: Hepatocellular carcinoma in cirrhotic patients generally c arries a poor prognosis either due to recurrence or to postoperative morbid ity or both. Several factors affect the prognosis of hepatocellular carcino ma resection as presence of cirrhosis of the liver, tumor diameter and tumo r capsullation.. Methodology: Thirty-eight patients with large hepatocellular carcinoma grea ter than 5cm with a background of cirrhotic liver were divided into two gro ups according to tumor diameter. Group A (n=20) with tumors less than 10cm in diameter, and group B (n=18) with tumors larger than 10cm. All patients underwent preoperative investigations including clinical laboratory tests, sonography, computed tomography, selective angiography and upper gastrointe stinal endoscopy. All patients were subjected to different types of hepatic resection. Results: A significant difference in tumor size, capsulation, and operation time were recorded between the two groups, of patients. No significant dif ference was detected between both groups regarding sex, age, viral markers, pathologic features, and Child classification. Hospital mortality occurred in 5% versus 11.1% of both groups, respectively. Postoperative jaundice an d ascitis occurred in 30%, 35% versus 44.4%, 72.0%, respectively (P <0.005, P <0.04). Late mortality occurred in 65% of patients in group A and in 77% of group B. Recurrence was detected in 42% of group A and 62% in group B. Recurrence after resection in capsulated tumors was significantly lower tha n in noncapsulated tumors in group A (P <0.01), but not significant in grou p B. Also, survival rate in patients with capsulated tumors was significant ly better in both groups (P <0.01) than that with noncapsulated tumors. Conclusions: Resection of hepatocellular carcinoma with diameter larger tha n 10cm recorded bad prognosis regarding recurrence and mortality rates than tumors less than 10cm. However, capsulated tumors gave better postoperativ e prognosis than noncapsulated ones.