Concurrent treatment of hepatocellular carcinoma and esophageal varices by hepatic resection and distal splenorenal shunt

N. Nagasue, H. Yukaya, Y. Ogawa, Y. C. Chang, H. Kohno and T. Nakamura
Second Department of Surgery, Shimane Medical University, Izumo, Japan.

Ten patients with both hepatocellular carcinoma (HCC) and esophageal or esophagogastric varices were concurrently treated by partial hepatic resection and distal splenorenal shunt. All the patients were men aged from 45 to 71 years. Four patients had had recent episodes of variceal bleeding. Six patients were considered to be at high risk for bleeding, as their varices were large and had "red color signs" endoscopically. Liver cirrhosis was associated with all cases. The grade of hepatic dysfunction was Child A in seven and Child B in three patients. As the HCCs were relatively small, partial wedge hepatectomy was carried out in all patients. Five patients underwent the original Warren shunt, but the remaining five had modified shunts with expanded polytetrafluoroethylene (Gore-Tex) interposition. There was no operative mortality within one month. Nine patients with patent shunts had no variceal bleeding despite the fact that three of them had tumor recurrence in the liver. Hepatic encephalopathy occurred transiently in only one instance. Six patients were alive at the time this report was written, eight to 49 months after operation. Five were free of cancer and one had tumor recurrence. This result may indicate that relatively small HCCs and esophageal varices can be simultaneously treated by limited hepatic resection and distal splenorenal shunt in patients with Child A or B liver disease.