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Brian Hung-Hin Lang, MBBS, MRCS(Edin); Ronnie Tung-Ping Poon, MS, FRCS(Edin); Sheung-Tat Fan, MS, MD, PhD, FRCS(Edin& Glasg); John Wong, PhD, FRACS

Arch Surg. 2003;138:1207-1213.

Hypothesis  Major hepatic resection is safe and provides favorable long-term survival for cirrhotic patients with a small solitary hepatocellular carcinoma.

Design  Retrospective case series.

Setting  Tertiary referral center.

Patients  From January 1, 1989, to December 31, 2001, 218 cirrhotic patients with a solitary hepatocellular carcinoma 5 cm or less in diameter underwent either a major hepatic resection (n = 84) or a minor hepatic resection (n = 134).

Major Outcome Measures  Perioperative morbidity and mortality, and long-term survival rates.

Results  The major resection group had significantly larger tumors (median, 3.5 vs 2.5 cm; P<.001) and better liver function (median indocyanine green retention at 15 minutes, 9.3% vs 12.9%; P<.001) than the minor resection group. Postoperative morbidity (46.4% vs 39.6%) and mortality (8.3% vs 3.0%) were higher in the major resection group than in the minor resection group, but the differences did not reach statistical significance (P = .32 and P = .11, respectively). The median overall survival did not differ significantly between the 2 groups (102.0 vs 72.3 months; P = .25). However, the median disease-free survival in the major resection group was significantly better than that in the minor resection group (59.0 vs 29.5 months; P = .03). On further subgroup analysis, both disease-free and overall survival rates were significantly better in the major hepatic resection group for tumors of 3 to 5 cm.

Conclusion  In well-selected cirrhotic patients with a small, solitary hepatocellular carcinoma, major hepatic resection is safe and may offer a better long-term survival over minor hepatic resection for patients with tumors of 3 to 5 cm.

From the Centre for the Study of Liver Disease and Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.

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