Surgical Treatment of Small Hepatocellular Carcinoma

Kim, Jae Chul; Kim, Dong Goo; Chung, Eun Sun

Abstract

PURPOSE: The hepatectomy has been regarded as the only curative treatment for small hepatocellular carcinomas. However, in recent years, non-surgical methods, such as ethanol injection therapy, arterial embolization, and high frequency coagulation, have come to be widely used in the treatment of small hepatocellular carcinomas. There have also been reports that survival rates comparable to those obtained by surgical resection can be achieved with non-surgical methods. In a retrospective analysis, the authors evaluated the surgical role in treating small hepatocellular carcinomas, regarding the survival rate and the pathological report. METHODS: Eighty-seven patients with a small hepatocellular carcinoma, defined as less than 5 cm in diameter, underwent a hepatectomy at our department during the 9 years between January 1990 and December 1998. We analyzed the pathologic findings, the operation method, and the survival rate as functions of the tumor size. RESULTS: Multiple nodules were presented in 18 (20.7%) of the 87 patients, and the incidence of multiple nodules was significantly higher for large-sized tumors. The incidences of capsule invasion, extranodular growth, and portal and intrahepatic metastasis were closely related to tumor size. For tumors less than 2 cm, no multiple nodules, portal invasion, or intrahepatic invasion was observed; however, very small incidences of capsule invasion and extranodular growth (27.3% and 11.1% respectively) and a high incidence (45.5%) of well differentiated tumors were noted. The operative mortality was 3.45% (3/87 hepatectomies): two died of hepatic failure, and one died of gastrointestinal bleeding. The 1-, 3- and 5- year survival rates were 86.9%, 72.0%, and 61.1%, respectively, and the tumor size and number were significantly related to survival rate the amount of resections however, was not significantly related to the survival rate. CONCLUSION: Tumors less than 2 cm in size have a good prognosis and are quite different pathologic ally compared to tumors, over 2 cm in size.