Experience with Resection of Primary Hepatic Malignancy

Abstract

Although hepatocellular carcinoma is one of the most common malignancies worldwide, primary hepatic malignancy (including hepatocellular carcinoma) is a relatively uncommon neoplasm in the United States and other Western countries. Nevertheless, the authors had treated 106 patients with primary hepatic malignancy by various kinds of hepatic resection by the end of 1987. The experience is summarized here with emphasis on operative mortality, some aspects of surgical technique, and long-term follow-up. Portions of our experience have been reported earlier. 5,6,[12][13][14][15][16] Case MaterialsDuring the 23-year period from October 1964 to December 1987, 411 patients underwent hepatic resection at the University of Colorado Health Sciences Center (1964Center ( to 1980 and the University Health Center of Pittsburgh (1981Pittsburgh ( to 1987. The number of hepatic resections increased sharply through the years (Table 1), 78 patients being treated in 1987 alone. The indications for hepatic resection in the total series were primary hepatic malignancy in 106 patients, secondary hepatic malignancy in 123 patients (including 90 patients with metastases from colorectal cancer), and histologically benign hepatic lesions in 182 patients. Histologic diagnoses of the 106 patients with primary hepatic malignancy are listed in Table 2. The liver was grossly cirrhotic in 16 of these 106 patients. The ages of the 106 patients ranged from 5 to 86 years old, with a mean of 55. Fifty-six were male, and 50 were female. Resection Techniques and ClassificationOur operative techniques have been described in detail elsewhere with emphasis on right trisegmentectomy and left trisegmentectomy. 13,14,16 The extent of hepatic resection was classified into the following six categories ( Fig. 1): right and left trisegmentectomy, right and left lobectomy, left lateral segmentectomy, and nonanatomic local resection. In brief, right trisegmentectomy is the complete removal of the right lobe plus the medial segment of the left lobe, where the caudate lobe is also completely removed or its left posterolateral portion is spared, depending on the location of the hepatic lesion. Extended right lobectomy, which removes only a portion of quadrate lobe and of the right side of the caudate lobe with the right lobe, was classified as right lobectomy in this report. Left trisegmentectomy is the complete removal of the left lobe plus the anterior segment of the right lobe, where the caudate lobe alongside the retrohepatic vena cava is removed or spared as dictated by the location of the hepatic lesion. Extended left hepatic lobectomy, which removes only a Nonanatomic local excision in our classification is not equivalent to "wedge resection." This type of hepatic resection was applied mostly for benign hepatic lesions, but when it was utilized for malignant lesions, the anatomic resection could not be done because of associated cirrhosis or the presence of severe cardiopulmonary disease. The tissue mass excised by nonanatomic local resection is ...

Resection, including transplantation, for hepatoblastoma and hepatocellular carcinoma: Impact on survival

“…Twenty patients were initially evaluated elsewhere, felt to be unresectable, and were then referred for OLT. Our transplant team, which has one of the world's largest experiences with partial hepatic resection, 15 performed partial hepatectomies whenever possible. However, because overall resectability rates for primary liver malignancies rarely exceed 30% to 40%, total hepatectomy and liver replacement is a logical alternative to achieve complete resection.…”

Primer Ve Metastatik Karaci̇ğer Tümörleri̇nde Tedavi̇ Yöntemleri̇

“…Rezeksiyon yapılamayanlarda transplantasyonla başarılı sonuçlar alınır. HCC a göre prognozları çok daha iyidir (3,4,5,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

66

“…Most reports demonstrated that right trisectionectomy was effective in extensive hepatic malignancy, based on some individuals with long-term survival [19,20] . But the risk (morbidity and mortality) of liver resection remains high according to some authors [20,22,23] , especially for primary liver cancer with cirrhosis. It is related to the fact that most primary liver cancer patients have a history of hepatitis and suffer a higher incidence of hepatic failure after major resection.…”