[Indications for limited hepatic resection in hepatocellular carcinoma]

Indications for limited hepatic resection in patients with hepatocellular carcinoma were evaluated by retrospective and clinicopathologic analysis of postoperative cases. Particular attention was paid to hepatic functional reserve and long-term prognosis. In our department, in order to estimate the hepatic functional reserve, indocyanine green clearance test (ICG), Child's classification and the oral glucose tolerance test have been applied. For instances, the incidences of hospital deaths were 17% and 19% in cases with an ICG-K value below 0.06 and between 0.06 and 0.08, which were high, compared with 6% and 3% in cases ICG-K values of with 0.08-0.10 and 0.10-0.12. On the other hand, by clinicopathologically analyzing 18 surviving patients or those surviving without recurrence for over 3 years after hepatic resection and 41 cases of small hepatocellular cancer less than 3 cm in diameter, those with capsule formation and without portal tumor invasion, intrahepatic metastasis and capsular invasion had a good long-team prognosis without recurrence even following limited resection. Particularly, patients with a surgical margin of over 1cm between the tumor and cut surface were candidates for long, non-recurrence survival. Form these results, the indications for limited hepatic resection for hepatocellular carcinoma were considered to be on ICG-K value of less than 0.08 in hepatic function and cases without venous invasion and extracapsular tumor invasion. In other cases, it is recommended that limited resection should be followed by multidisciplinary treatment.