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Is hepatic resection absolutely contraindicated for hepatocellular carcinoma in Child-Pugh class C cirrhotic
Insights
Liver resection for hepatocellular carcinoma (HCC) in Child-Pugh class C patients is feasible. Selected patients with HCC and Child-Pugh class C cirrhosis can undergo hepatectomy with comparable outcomes to Child-Pugh class A, despite narrower margins.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Hepatology
Background:
- Hepatocellular carcinoma (HCC) in Child-Pugh class C cirrhotic patients is often considered high-risk or contraindicated for liver resection.
- This study investigates the outcomes of hepatectomy for HCC in this challenging patient group.
Purpose of the Study:
- To evaluate the safety and efficacy of liver resection for HCC in patients with Child-Pugh class C cirrhosis.
- To compare outcomes between Child-Pugh class A and C cirrhotic patients undergoing hepatectomy for HCC.
Main Methods:
- Retrospective review of clinicopathological features and resection results.
- Comparison of Child-Pugh class A (n=181) and class C (n=13) patients.
- Hepatectomy extent guided by pre-operative liver function tests and indocyanine-green (ICG) clearance rates.
Main Results:
- Tumor size was smaller in class C patients.
- No significant differences in operative blood loss, transfusion, morbidity, or mortality between groups.
- Class C patients had narrower surgical margins (p=0.003) but higher incidences of well-formed capsules and absence of satellite nodules.
- 5-year disease-free survival: 35.4% (A) vs 40.7% (C), p=0.28.
- 5-year actuarial survival: 48% (A) vs 50% (C), p=0.13.
Conclusions:
- Liver resection is not universally contraindicated for HCC in Child-Pugh class C cirrhotic patients.
- Surgical resection can be justified in selected Child-Pugh class C cases without severe ascites, jaundice, or encephalopathy.
- Outcomes can be comparable to Child-Pugh class A patients, even with narrower surgical margins.
Background/Aims:
Liver resection for hepatocellular carcinoma (HCC) in Child-Pugh class C cirrhotic patients is considered to be high risk and even contraindicated. This study examined our results of hepatectomy for HCC in such cirrhotic patients.
Methodology:
A retrospective review of the clinicopathological features, as well as early and late resection results of Child-Pugh class A (n = 181) and class C patients (n = 13) were compared. The extent of hepatectomy was based on the pre-operative liver function test and indocyanine-green (ICG) clearance rate.
Results:
The tumor size in class C patients was smaller than that in class A patients. There were no significant differences with regard to operative blood loss, amount of blood transfusion, operative morbidity or mortality. The surgical margins of class C patients were narrower (p = 0.003). The tumors of class C patients had higher incidences of well-formed capsules and absence of satellite nodules. The 5-year disease-free and actuarial survival rates of class A and C patients were 35.4% and 40.7% (p = 0.28), and 48% and 50% (p = 0.13), respectively.
Conclusions:
Not all HCCs in Child-Pugh class C cirrhotic patients are contraindicated for liver resection. In the absence of uncontrollable ascites, marked jaundice and encephalopathy, surgical resection is still justified in some selected cases, in spite of a narrow surgical margin.