A Clinical Study of Surgically Resected Primary Liver Cancer

Nam, Dong Kuk; Choi, Chang Soo; Choi, Young Kil

Abstract

Sixty-two patients with primary liver cancer were treated by surgical resection during a period of 10 years. There were 41 hepatocellular carcinomas, 19 cholangiocellular carcinomas, one mixed hepatocellular and cholangiocellular carcinoma, and one hepatoblastoma. Liver cirrhosis and positive hepatitis B surface antigen were noted in 78.0% and 75.7%, respectively, of the patients with hepatocellular carcinomas. In cholangiocellular carcinomas, clonorchiasis and hepatolithiasis were common associated diseases. The tumor was larger than 5 cm in 61.3% of the patients, and was multiple in 21.0%. Multiplicity of the tumor was more common in hepatocellular carcinomas, and regional lymph node metastases were present in 47.4% of the cholangiocellular carcinomas. The types of surgical procedures were a trisegmentectomy in one patient, an extended lobectomy in four, a lobectomy in 24, a segmentectomy in 12, a subsegmentectomy in 11, and a partial resection in 10. A curative resection with a negative resection margin was obtained in 75.8% of the patients. Operative morbidity developed in 29 patients (46.8%), and pulmonary problems, wound infection, and intra-abdominal abscess were common complications. The operative mortality was 3.2% (two out of 62 patients). The overall cumulative 5-year survival rate was 24.6%, and the median survival time was 14.0 months. The cumulative 5-year survival rate for hepatocellular carcinomas and cholangiocellular carcinomas were 28.2% and 20.0%, respectively. The presence of capsule formation, the absence of vascular invasion, a tumor-free resection margin, and the absence of associated liver cirrhosis were favorable prognostic factors. In patients with hepatocellular carcinomas, a high level of serum alpa -fetoprotein and a large tumor (over 5 cm) were significantly related to a shorter survival time.