Hepatic segmentectomy for curative resection of primary hepatocellular carcinoma
W. Y. Lui, G. Y. Chau, C. C. Loong, S. H. Tsay, J. C. Wu, K. L. King, J. H. Chiu, C. R. Lai and F. K. P'eng
Department of Surgery, Veterans General Hospital-Taipei, National Yang-Ming University, Taiwan, Republic of China.
OBJECTIVES: To evaluate the feasibility and results of segmentectomy for
curative resection of hepatocellular carcinoma and to compare the
clinicopathological findings of the patients according to the tumor
location in the liver. DESIGN: Case series. SETTING: A tertiary care
center. PATIENTS: Seventy-five patients with Child's grade A or B liver
function who had hepatocellular carcinoma that was confined to one segment
and who underwent segmentectomy for curative resection of the tumor. The
patients were divided into four groups: group P (posterior segmentectomy, n
= 23); group A (anterior segmentectomy, n = 10); group M (medial
segmentectomy, n = 16); and group L (lateral segmentectomy, n = 26). MAIN
OUTCOME MEASURE: Disease-free survival rate. RESULTS: Seventy-three percent
of the patients had cirrhosis of the liver. The surgical mortality and
morbidity rates were 5.3% and 36.0%, respectively. The 1-, 3-, and 5-year
disease-free survival rates were 61.9%, 39.1%, and 26.3%, respectively, and
were not significantly different among the four groups (P = .86). Group L
had the least operative blood loss and shortest operative time when
compared with the other three groups (P < .05). The postoperative liver
function changes were mild and transient in the four groups of patients.
With regard to pathological factors, only tumor size differed among the
groups (tumors in group L were significantly larger than those in the other
three groups, P < .05). Forty-three percent of the recurrent tumors were
solitary in the early stage, with 81% involving the segment(s) adjacent to
the resected one and 57% being confined solely to the segment adjacent to
the resected segment. Patients having recurrent hepatocellular carcinomas
had significantly larger tumors at the time of resection than did those
without recurrence (P = .03). CONCLUSIONS: Hepatic segmentectomy is an
effective therapeutic approach for small hepatocellular carcinomas and can
be done safely even in patients with chronic liver disease and impaired
liver function.
