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Is There a Way? A Prospective Analysis of Our Approach

Guido Torzilli, MD, FPCR; Masatoshi Makuuchi, MD, PhD; Kazuto Inoue, MD; Tadatoshi Takayama, MD, PhD; Yoshihiro Sakamoto, MD; Yasuhiko Sugawara, MD; Keiichi Kubota, MD, PhD; Alberto Zucchi, MD

Arch Surg. 1999;134:984-992.

Background  Low resectability rates and significant morbidity and mortality rates often make surgery for hepatocellular carcinomas (HCCs) unfeasible.

Hypothesis  Our policy for surgical treatment of cirrhotic and noncirrhotic patients with HCC is adequate and safe.

Design  Prospective validation cohort study.

Setting  University hospital.

Patients  One hundred seven consecutive patients with HCCs. Associated cirrhosis was present in 64 (59.8%), and only 7 (6.5%) had normal livers.

Interventions  The presence of ascites, serum bilirubin level, and indocyanine green retention rate at 15 minutes were considered when selecting patients for surgery. Preoperative recovery of liver function was achieved with portal venous branch embolization, liver volumetry, bed rest, and control of serum aminotransferase levels. The surgical techniques mainly involved bloodless dissection using intraoperative ultrasonography and intermittent warm ischemia. The main perioperative care regimen was fresh frozen plasma infusion and strict limitation of blood transfusion.

Main Outcome Measures  The 30-day postoperative mortality and morbidity rates.

Results  All the patients underwent surgery (37 major resections, 45 segmentectomies, and 25 limited resections), with no 30-day postoperative mortality, overall morbidity of 26.2%, and no major complications. Multiple logistic regression analysis revealed that only the type of operation was associated with a significantly higher morbidity risk (P=.05).

Conclusion  With high resectability, low morbidity, and no mortality, our policy represents a solution to the drawbacks of surgical resection for treatment of HCCs, especially in patients with associated liver cirrhosis.

From the HepatoBiliary Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (Drs Torzilli, Makuuchi, Inoue, Takayama, Sakamoto, Sugawara, and Kubota); and the Epidemiology Unit, Hospital of Lodi, Lodi, Italy (Dr Zucchi).

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