Analysis of factors affecting outcome after hepatectomy of patients with liver cirrhosis and small hepatocellular carcinoma

Objective: To review our policy of screening patients at risk of developing hepatocellular carcinoma (HCC), and to present 10 years' experience of hepatic resection for small HCC (<5 cm). Design: Retrospective study. Setting: Teaching hospital, Germany. Subjects: 861 patients with hepatic cirrhosis and oesophageal varices of whom 151 (18%) had HCC confirmed histologically; 30 of these tumours (20%) were less that 5 cm in diameter and suitable for resection. Interventions: Segmentectomy (n = 14) bisegmentectomy (n = 10), and oncologically defined wedge resection (n = 6). Main outcome measures: Mortality, morbidity, and survival. Results: 4 patients died within 30 days of liver failure and sepsis (n = 2), liver failure (n = 1), and bronchopueumonia (n = 1). The main beneficial prognostic factors were Child classification, donation of autologous blood, and an encapsulated tumour. The main indicators of a poor prognosis were invasion of the Liver, venous invasion, invasion of the resection margin, and the presence of microsatellite tumours and nodules. 12 of the 26 survivors developed recurrences during the first five years postoperatively (46%). Kaplan-Meier survival curves showed that survival at 1 year was 80%, at 3 years 65%, and 5 years 50%, and at 10 years 30%. Conclusion: Hepatic resection is a useful treatment for small HCC, but its success depends on early detection and careful selection of patients.