Hepatic resection for hepatocellular carcinoma in severely cirrhotic livers

Liver resection for hepatocellular carcinoma is typically avoided in patients with severe cirrhosis, as this may predispose patients to pronounced surgical risks and worse long-term outcomes. This study examined our results of hepatectomy for hepatocellular carcinoma in patients with different degrees of impaired liver function.

A retrospective comparison of background characteristics and operative results in patients with resected hepatocellular carcinoma was performed, with patients classified as having either severely impaired liver function (High Group, preoperative indocyanine green 15-minute retention rate > or = 30%; n = 22) or normal liver function (Low Group, indocyanine green 15-minute retention rate < or = 10%; n = 37).

The preoperative liver function of those in the High Group was significantly worse than those in the Low Group. Despite similar tumor diameters between groups, the amount of liver resected in the High Group was significantly smaller than in the Low Group, primarily because of more limited resections with narrow margins in the former. However, patients in the High Group had similar recurrence and survival rates when compared to those in the Low Group whose resections included wide surgical margins. In analyzing those that did or did not undergo transcatheter arterial chemoembolization prior to resection, a better disease-free and actuarial survival rate was observed in the High Group with preoperative transcatheter arterial chemoembolization compared to those without transcatheter arterial chemoembolization or those in the Low Group with transcatheter arterial chemoembolization.

For patients with limited liver function reserve, such as those in the High Group, resection of hepatocellular carcinoma with preservation of liver parenchyma may take priority over a wide resection margin. In addition, we suggest the use of preoperative transcatheter arterial chemoembolization in selected patients with severe cirrhosis undergoing resection of hepatocellular carcinoma.