Author(s): Mazziotti A, Grazi GL, Cavallari A
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Abstract Recent improvements on the therapeutical management of hepatocellular carcinoma (HCC) on cirrhosis have led to further evaluate the role of surgery for this disease. In a 15-year period we have evaluated 532 cirrhotics with HCC on cirrhosis. Contraindications for surgery were founded in 170 (31.9\%); 37 of them received a transarterial chemoembolization and 2 a percutaneous ethanol injection. Laparotomy was performed in 315 (59.2\%) cases, but in 77 surgical treatment was contraindicated due to unexpected intraoperative findings. A liver resection was performed in 238 (44.7\%) patients, representing the 26.1\% of all liver resections performed at our Department. Seventy-eight (32.8\%) were subsegmentectomies, 143 (60.1\%) segmentectomies (including 1 to 3 anatomical segments) and 17 major hepatectomies. Overall 30-day mortality was 4.6\%: 9.3\% during years 83-91 and 0.8\% during following years (P<0.005). Five-year actuarial survival rate was 41.3\%. The remaining 47 (8.8\%) patients were placed on the waiting list for orthotopic liver transplantation (OLT) and 41 already operated on. Operative mortality was 6.2\% and 5-year actuarial survival rate 58.1\%. The persistent shortage of organ donor represents the major factor limiting the application of liver transplantation for a larger number of patients carrying HCC on cirrhosis. Liver resection remains the option to be considered for all the patients with such a disease, even if in a large proportion of cases this procedure offers only a limited survival.
This article was published in Hepatogastroenterology
and referenced in Journal of Liver