Hepatic resection for hepatocellular carcinoma associated with liver cirrhosis

Abstract

Sixty‐three patients with hepatocellular carcinoma associated with cirrhosis received various kinds of treatment at our clinic during the past 21 years. Of these, 35 patients who underwent hepatic resection were divided into a large tumor group (tumors more than 5 cm in diameter) and a small tumor group (tumors less than 5 cm in diameter), and the operative results of both groups were studied. There was a difference in the average ages between the 2 groups (p <0.05), but there was no difference in the duration of illness or laboratory data. The resectability rate of the liver in 17 patients with small tumors was 89% and was significantly higher than that of 41% in 18 patients with large tumors (p<0.005). The overall operative mortality rate was 14% for both groups. Patients with tumors over 3 cm already exhibited the histological findings seen in advanced cancer. Cumulative 3‐year survival rates of the large and small tumor groups were 0% and 53%, respectively, and there was a significant difference in survival curves between the 2 groups (p<0.005). The above results suggest that hepatic resection for patients with small tumors is effective as a treatment for hepatoma associated with cirrhosis.

Ethnic differences in the behavior of hepatocellular carcinoma

“…These rates are comparable to results in other Asian and Western studies. 5,20 Similarly, in both Western and Asian series, AFP positivity has been shown to be an independent risk factor for poor prognosis by multivariate analysis. 20,21 Advanced age as an adverse prognostic factor has been demonstrated in some studies 22 but not in others.…”

“…Even after successful resection, there is a 50% recurrence rate 3 and overall survival hovers between 20-40% in various series. 4,5 In southeast Asia and sub-Saharan Africa, HCC is a prevalent cause of cancer death. Hepatitis B and C viruses and aflatoxin exposure have been identified as risk factors in these populations.…”

Risk Factors for Hepatocellular Carcinoma in India

“…A positive association of cirrhosis of the liver in 80-90% of patients with HCC has been demonstrated in reports from Northern regions. [12][13][14][15][16][17] Oka et al 1990 18 found the yearly incidence rate of HCC in cirrhotics varies from 3% in the West 19 to as high as 11% in Japan. Tsukuma et al1990 8 in a prospective study from Japan reported liver cirrhosis and viral hepatitis as risk factors for HCC, each carrying a 3-year cumulative risk of 12.5 and 3.8%, respectively.…”

Review: Research Toward Safer Resectionof the Cirrhotic Liver

“…Unlike the normal liver, which, within [3][4][5][6][7][8][9][10][11][12] months can regenerate to its original size and function, even after 80% resection, the cirrhotic liver has impaired regenerative ability. Indeed, until recently, the cirrhotic liver was thought to be unable to regenerate [7].…”

“…Conversely, 10-20% of patients with cirrhosis from any etiology, will go on to develop HCC [3,6]. Thus, the majority of patients who require resection also have cirrhosis or impaired liver function.…”