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Is It Justified?

Chi-Leung Liu, MS, FRCS; Sheung-Tat Fan, MS, MD, FRCS; Chung-Mau Lo, MS, FRACS, FRCS; Irene Oi-Lin Ng, MD, FRCPath; Ronnie Tung-Ping Poon, MS, FRCS; John Wong, PhD, FRACS, FRCS

Arch Surg. 2003;138:100-104.

Hypothesis  Patients with bilobar stage IVa hepatocellular carcinoma (HCC) are generally considered unsuitable for hepatic resection. Recent data suggest that palliative hepatic resection in selected patients with advanced HCC may result in a favorable survival outcome. The aim of the present study was to evaluate the operative outcome and survival benefits of hepatic resection for patients with bilobar HCC.

Design  Retrospective study.

Setting  Tertiary referral center.

Patients  The study comprised 78 patients who were diagnosed as having unilobar HCC and considered initially suitable candidates for curative hepatic resection on preoperative investigations from 1989 to 2000. Bilobar disease with discrete tumor nodules in the contralateral lobe was diagnosed in these patients on laparoscopy (44 patients) or laparotomy (34 patients) with the help of intraoperative ultrasonography. Fifteen patients (19%) underwent palliative hepatic resection (group A), and hepatic resection was not performed in the remaining 63 patients (81%) (group B).

Main Outcome Measures  The clinicopathologic data and operative and survival outcomes of both groups of patients were compared.

Results  The clinicopathologic parameters were comparable in both groups of patients. In group A, 12 patients (80%) underwent major hepatic resection, and the mean ± SEM size of the resected tumors was 8.3 ± 0.9 cm. The operative morbidity and mortality were 20% and 0%, respectively. Treatment for tumors in the contralateral lobe included wedge excision (5 patients), alcohol injection (5 patients), cryotherapy (2 patients), and transarterial oily chemoembolization (3 patients). In group B, treatment for HCC included transarterial oily chemoembolization (42 patients), systemic chemotherapy (3 patients), transarterial oily chemoembolization and systemic chemotherapy (5 patients), cryotherapy (2 patients), tamoxifen (3 patients), and no treatment (8 patients). The median survival of patients in group A was 19.5 months, with 4 patients surviving for more than 3 years. The survival in group A was significantly better than in group B (median = 7.1 months; P = .008). On multivariate analysis, hepatic resection and preoperative serum -fetoprotein level were the 2 independent factors that significantly affected patient survival.

Conclusions  Hepatic resection for HCC in patients with stage IVa bilobar disease results in a better survival outcome than nonresectional therapies. It should be considered in selected patients with low operative risks and satisfactory liver function.

From the Centre for the Study of Liver Disease and the Departments of Surgery (Drs Fan, Wong, Liu, Lo, and Poon) and Pathology (Dr Ng), University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.

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