[Surgical treatment of hepatocellular carcinoma--indications, limitations, realities]

The present study analyzes the importance of the factors in improving the resectability, obtaining morbidity and mortality rates in accordance to the actual exigencies. In The III-rd Surgical Clinic, "Sf.Spiridon" Hospital, Iaşi, during 1998-2003, 24 cases of CHC (19 men, 5 women with a median age of 58.5 years), usually developed on a cirrhotic liver, benefited by surgical approach. The tumoral mass (median size 7.8 cm) was situated in the left liver (15 cases--62.5%), right liver--13 cases and for 1 case with multiple localization (the segments VI-VII and III). For 12 cases (50%) various extensions of liver resections have been undergone: left lobectomies II-III--4 cases, left hepatectomy--1 case, segmentectomies VI--3 cases, segmentectomy III + bisegmentectomy VI-III--1 case, atypical hepatectomy--3 cases. Only 2 cases benefited by right portal vein ligation prior to resection. In 12 cases intraoperative exploration and US examination (4 cases) contraindicated the resection. One patient deceased on the entire lot (4.16%); post-resection mortality--8.33%. In conclusion, the early diagnostic of CHC developed on cirrhotic liver, the patients selection, the use of laparoscopy and intraoperative US, the available devices (CUSA dissector), selective ligation of portal branch prior to resection represents imperative elements in improving the resectability in safe conditions for the patient.