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Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy
Published on: March 10, 2023
Surgical therapy of hepatocellular carcinoma in the cirrhotic liver
1Centre of Liver Diseases, University of Hong Kong, Queen Mary Hospital, China.
Insights
Hepatectomy for liver cancer in cirrhotic patients is now safer. Improved surgical techniques and perioperative care significantly reduced hospital mortality and improved survival rates for hepatocellular carcinoma patients with cirrhosis.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Hepatectomy for hepatocellular carcinoma (HCC) in cirrhotic patients historically carried high mortality rates.
- This led to the perception of contraindication for major hepatectomy in this patient group.
Purpose of the Study:
- To report a refined surgical approach for hepatectomy in cirrhotic patients with HCC.
- To evaluate the impact of this approach on perioperative mortality and long-term survival.
Main Methods:
- A retrospective analysis of 98 cirrhotic patients undergoing hepatectomy (66 major, 32 minor) between 1989 and 1995.
- Patient selection based on indocyanine green clearance tests.
- Surgical techniques focused on minimizing blood loss, ischemic injury, and preserving liver parenchyma.
- Postoperative care aimed at maintaining or improving liver function.
Main Results:
- Hospital mortality for cirrhotic patients undergoing hepatectomy decreased from 40% in 1989 to 5% in 1995.
- The 5-year survival rate improved to 41.2%, comparable to patients with normal or chronically diseased livers.
Conclusions:
- Refined surgical techniques and perioperative management have made hepatectomy a viable and beneficial option for cirrhotic patients with HCC.
- This approach significantly improves outcomes, challenging previous contraindications.
Abstract:
Hepatectomy for hepatocellular carcinoma (HCC) associated with cirrhosis was considered by some surgeons contraindicated because the hospital mortality rate, especially for major hepatectomy, was very high. The author reported his surgical approach to hepatectomy associated with cirrhosis. Between 1989 and 1995, 66 major hepatectomies and 32 minor hepatectomies were performed in 98 cirrhotic patients. The selection of patients for hepatectomy was based on results of indocyanine green clearance test. The surgical technique was designed to reduce blood loss, ischaemic injury to the liver remnant and preservation of liver parenchyma. The postoperative care was designed to maintain or improve liver function. By such an approach, the hospital mortality rate of the cirrhotic patients having hepatectomy decreased from 40% in 1989 to 5% in 1995. The 5-year survival rate also improved to 41.2%, which is not statistically different from that of those with a normal liver or chronic hepatitis. With refinement in surgical technique and perioperative care, patients with cirrhosis can also benefit from hepatectomy for HCC.
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