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Surgical resection for hepatocellular carcinoma in Cape Town--a clinical and histopathological study
E R Lemmer1, J E Krige, P M Hall
1Medical Research Council/University of Cape Town Liver Research Centre.
Objective:
Review of surgical resections performed for hepatocellular carcinoma (HCC) at our institution between 1990 and 1996, histology of resected specimens, and clinical outcome.
Design:
Retrospective and prospective study of 14 patients who underwent resection for HCC.
Setting:
The Hepatobiliary Unit and Liver Clinic, Groote Schuur Hospital, Cape Town.
Patients:
Fourteen patients who underwent liver resections for HCC.
Interventions:
Hepatic resections using prolonged vascular inflow occlusion.
Outcome Measures:
Clinical outcome and disease-free survival following resection.
Results:
Fourteen patients (5.6% of the total number presenting with HCC) underwent liver resection for HCC at our institution between 1990 and 1996. There were 7 men, median age 40 years (range 18-74 years). Only 2 patients were black, and only 1 of these patients had evidence of hepatitis B virus (HBV) infection in the liver. Extensive liver resections were often required. The mean (SD) ischaemic time was 81 (26) minutes and mean estimated blood loss was 938 (649) ml. During hospital admission, 1 patient developed a minor bile leak that settled spontaneously, and 1 patient suffered a stroke and died. The mean hospital stay following operation was 12 days (range 7-21 days). Disease-free patient survival at 1, 2 and 3 years was 85%, 75%, and 62%, respectively. Histopathology of the resected specimens showed that 10 of 14 tumours had arisen in non-cirrhotic livers. Mean tumour size was 10.6 (4.6) cm. Only 1 specimen showed the fibrolamellar variant of HCC.
Conclusions:
Only a small proportion of patients with HCC seen at Groote Schuur Hospital were eligible for resection, and only a minority of these had HBV-associated 'African' HCC. The results of hepatic resection at our institution compare favourably with literature reports, despite the relatively large size of the tumours. It is of interest that most tumours arose in non-cirrhotic livers. There was no evidence of proliferation of 'oval-like' cells in non-neoplastic liver tissue.