Improved results of liver resection for hepatocellular carcinoma on cirrhosis give the procedure added value

Objective To review a single-center experience to update the performance indexes of l iver resection (LR), Summary Background Data Several therapies have been proposed in the treatment of hepatocellular car cinoma (HCC) on cirrhosis, although LR was the first to be widely applied. Methods Of 408 patients with cirrhosis admitted for HCC in the period 1983 to 1998, 264 had a LR. Patient selection, surgical technique, 30-day deaths. long-t erm survival, recurrence rate, and recurrence treatment were reviewed after stratifying patients according to the year of surgery. Mean follow-up was 34.5 +/- 29.1 months. Results The number of Child A patients who underwent surgery after the discovery of the tumor at routine evaluation increased significantly from 64.5% to 87.9 % during the study period. Procedures carried out without blood transfusion s increased from 31.4% to 76.9%, The overall operative death rate was 4.9%, Actuarial survival rates were 63.1% and 41.1% after 3 and 5 years, respect ively; actuarial tumor-free survival rates were 49.3% and 27.9% at the same intervals. After 1992, surgical deaths decreased from 9.3% to 1.3%. Actuar ial survival rates increased from 52.9% and 32.3% to 71.7% and 49.4% after 3 and 5 years, respectively. There was no difference in the actuarial recur rence rate between the two periods, but the chance to treat recurrence incr eased over time from 22.4% to 53.7% with a concomitant, significant improve ment in survival. Conclusions LR represents a well-established therapy for HCC on cirrhosis. II remains o ne of the fundamentals in the multidisciplinary approach to this tumor and should be considered as the first option for patients with preserved hepati c function and limited disease. Today, LR should offer a surgical death rat e of less than 1.5%, a S-year survival rate oi approximately 50%, and a 5-y ear tumor-free survival rate of 28% when performed in specialized centers.