Experience with major hepatic resections for hepatocellular carcinoma

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Hepatocellular Carcinoma Research

Background:

• Hepatocellular carcinoma (HCC) presents significant treatment challenges, particularly in cases of spontaneous rupture.
• Patient profiles often include co-existing conditions such as Hepatitis B surface antigen (HBsAg) positivity and liver cirrhosis.
• Elevated alpha-fetoprotein (AFP) levels are common indicators in HCC patients.

Purpose of the Study:

• To evaluate the efficacy and safety of aggressive surgical management for hepatocellular carcinoma.
• To assess outcomes in patients undergoing major hepatic resections for HCC, including emergency presentations.
• To highlight the diagnostic utility of ultrasonography in acute abdominal conditions suggestive of HCC rupture.

Main Methods:

• Performed nine major hepatic resections for hepatocellular carcinoma over a 2-year, 4-month period.
• Utilized ultrasonography as a critical emergency diagnostic tool for acute abdomen presentations.
• Collected data on patient demographics, HBsAg status, preoperative alpha-fetoprotein levels, and presence of liver cirrhosis.

Main Results:

• No operative mortality or morbidity was observed in the series.
• Two patients with spontaneous rupture of HCC underwent successful resection.
• Post-resection follow-up (3-31 months) showed all but one patient alive and without evidence of disease.

Conclusions:

• Aggressive surgical treatment for hepatocellular carcinoma, even in ruptured cases, is associated with excellent outcomes.
• Major hepatic resection is a viable and effective treatment modality for selected HCC patients.
• Ultrasonography plays a crucial role in the emergency diagnosis of ruptured HCC.