Resection of malignant primary liver tumors

Malignant primary liver tumors are an uncommon and challenging surgical problem. In spite of multimodality therapies, surgical resection remains the mainstay of treatment and the most likely chance for cure. We reviewed the 13-year resection experience of a single surgeon at our institution to evaluate the results.

A retrospective review from July 1982 to June 1995 was performed for patients presenting with a diagnosis of primary liver cancer. Those undergoing resection of their primary liver tumors form the basis of this report.

One hundred eighty-four patients with a diagnosis of primary liver cancer were seen at our institution. Of these, 43 patients underwent 46 resections of their cancers by a single surgeon. There were 22 females (51%) and 21 males (49%). The average age was 61 years with a median age of 63 years (range, 19-85 years). Tumors resected included 27 hepatomas, 16 cholangiocellular carcinomas, 1 carcinoid tumor, 1 low grade mucinous cystadenocarcinoma, and 1 cystadenocarcinoma. Resections were as follows: 9 right trisegmentectomies, 8 right lobectomies, 1 left trisegmentectomy, 4 left lobectomies, 7 left lateral segmentectomies, and 17 partial lobectomies. Major complications occurred in 11 patients (26%). There were 3 deaths, for a 30-day perioperative death rate of 7%. Of the 43 patients, 13 had follow-up of less than 12 months and 30 had follow-up for more than 1 year. The mean survival of the 30 patients who had their tumors resected and were followed up for more than 1 year was 27.2 months and the median survival was 21 months. The median survival of patients not undergoing resection was less than 6 months. The 1-, 2-, 3-, and 5-year survival rates were 57%, 52%, 40%, and 33%, respectively.

Primary liver cancer can be treated by resection with acceptable results. This remains the standard treatment of any liver cancer. Survival rates of patients after resection are much better than survival rates of patients who do not undergo surgery.