Conservative hepatic resection for hepatocellular carcinoma of cirrhotic patients

We evaluated in retrospect the applicability of conservative hepatic resection for hepatocellular carcinoma (HCC) of cirrhotic patients. Eighty (14.6%) of 548 patients with HCC underwent liver resection over a period of 10 years in this hospital. They were divided into two groups according to surgical procedures. In group I, 22 patients underwent major hepatic resection, and in group II, 58 patients underwent conservative liver resection. The operative mortality for patients in group I was 13.6% while it was 3.5% for those in group II. The difference was significant (p<0.05). The five-year survival rate was 22% for patients in group I, while it was 21% for group II patients. The rate of HCC recurrence was 47.4% for group I patients while it was 57.1% for group II patients. The difference was not significant. The tumor-free survival rates at 6-, 12-, 24- and 36-months were 80%, 75%, 55% and 55% respectively for patients in group I, while they were 50%, 42.5%, 42.5% and 42.5% for patients in group II. It suggested that conservative liver resection was associated with early recurrence of HCC. But the difference of mean tumor-free survival time is not significant (35.82+/-5.47 vs 38.63+/-8.05 months, p>0.05). Using Cox's regression analysis, the presence of Child's B was identified as an independent adverse prognostic factor (p=0.000) for long-term survival. The factors associated with poor tumor-free survival rate were Child's classification (p=0.008), metastasis (p=0.021), liver cirrhosis (p=0.039) and tumor size (p=0.054). By evaluating the operative mortality, long-term survival rate, prognostic factors for cumulative survival time and tumor-free survival time, it suggests that conservative liver resection can be selectively used to treat HCC associated with liver cirrhosis.