[Indication of minimized regional operation for primary liver cancer]

In the cirrhotic patient with inadequate liver functional reserve, curative standard resection due to anatomic basis often lead to liver failure postoperatively. Therefore, prognosis and resectability remained unsatisfactory for these patients. Definition of minimized regional operation which is performed to the patient with decreased functional reserve of the liver is not clearly determined. In our department, definition of minimized regional operation is made as follows. 1. The liver is impaired to more than moderate degree. (Child B and C or decreased liver functional reserve) 2. Maximum tumor diameter is less than 5 cm. 3. The extent of resection is less than subsegmentectomy. Study of 23 patients undergoing this minimized regional operation was made and the result is as follows. In relation of extent of resection to tumor diameter, in patients with less than 3 cm tumor recurrence developed only in one (7.6%) of thirteen patients undergoing minimized regional operation and none of four undergoing conventional standard resection. While in patients with more than 3 cm tumor, recurrence was found in two (25%) of eight patients with minimized regional operation and three (60%) of five patients with resection of one segment. In relation of the extent of resection to tumor capsule, in patients with less than 3 cm tumor with capsule, minimized regional operation and three standard resections were performed and in none of which recurrence developed. In patients with less than 3 cm tumor without capsule, recurrence developed in one of four patients undergoing minimized regional operation. While in patients with more than 3 cm tumor, recurrence developed in two (25%) of eight patients with tumor possessing capsule and three (60%) of five patients without capsule. As a result, in patients with less than 3 cm tumor diameter, minimized regional operation is acceptable with little recurrence but in patients with more than 3 cm tumor with or without capsule, anatomic lobe resection is necessary and resection of more than two segments is mandatory if functional reserve of the liver allows. In our department, extent of resection is determined by the functional reserve of the liver which is graded into three degree. For subsegmentectomy, following laboratory date has to be met: ICG-Rmax greater than 0.4, sigma IRI/sigma BS greater than 0.2, Ch-E greater than 500 IU/1, Total Bil. less than 2.5 mg/dl, S-Alb greater than 3.0 g/dl, GPT less than 300 IU and HPT greater than 50%.(ABSTRACT TRUNCATED AT 400 WORDS)