Objective: To compare the patients’ characters, clinical features, tumor behavior, short term and long term outcomes among patients with small HCC in cirrhosis after minor or major hepatectomy.
Methods: From 1982 to 2001, total 1230 patients received hepatectomy for HCC in the Chang Gung Memorial Hospital, Taipei, Taiwan. A total of 446 patients were enrolled into the study according to the inclusion criteria of tumor size ≦5cm, liver cirrhosis, and resection margin free of tumor microscopically. There were 344 male and 102 female with ages ranging from 4 to 85 year-old, median 58 year-old. Among them, 114 patients received minor hepatectomy (wedge resection or one segment only), and 332 received major hepatectomy (at least two segments).
Results: Follow-up ranged from 1 to 176 months, median 34.2 months. The demographic data were similar in age, sex, associated disease, and virus hepatitis pattern. The tumor characters were also similar including of capsule, capsular invasion, vascular invasion, daughter nodules, resection margins, and maximal tumor sizes. Patients with minor resection had higher AFP level (p=0.039), lower hemoglobin (p=0.028), lower hematocrit (p=0.027), lower platelet counts (0.037), lower albumin (p=0.017), higher bilirubin (p=0.031). Minor hepatectomy had shorter operative time (p= 0.001), but the blood loss, the frequency of use inflow control, surgical morbidity, in hospital mortality rate were similar in both groups. By Kaplan-Meier survival analysis and log-rank test, there is no statistical significance regarding the recurrence and survival rates between the two groups.
Conclusions: Attempt to apply minor or major hepatectomy for small HCC with cirrhosis may be according to tumor location, patient's condition and the experience of surgeon. The type of resection do not influence patient's outcome if the curative resection is obtained.