Prognosis for a Hepatocellular Carcinoma Smaller Than 5 cm in Relation to Hepatic Resection: Major Resection vs Limited Resection

Kim, Ki Hun; Lee, Sung Gyu; Lee, Young Joo; Park, Kwang Min; Hwang, Shin; Choi, Dong Lak; Nam, Chung Hyun; Min, Pyung Chul

Abstract

BACKGROUND: A hepatocellular carcinoma (HCC) is an awesome malignancy; survival time is usually less than 1 year once symptoms and signs appear, irrespective of treatment. Screening tools are now available that make it possible to detect a preclinical HCC, which is usually small and surgically resectable. We studied the prognosis after hepatic resections of HCCs smaller than 5 cm and tried to clarify which effective treatments correlated with high survival rates by comparing the outcomes of major hepatic resections with those of limited hepatic resections.
METHODS
Of the 105 cases treated from January 1, 1990, to December 31, 1998, at Asan Medical Center, all proved surgically to be small HCCs and pathologically to be HCC types. There were two categories of patients: those receiving a major hepatic resection (n=48) and those receiving a limited hepatic resection (n=57).
RESULTS
The median age was 53 (range, 33-69), and the male:female ratio was 42:6 in the major resection group. The median tumor size was 3.4 cm, and the median resection margin was 2.6 cm. Major resections were done in 48 cases, including right lobectomies (32 cases), left lobectomies (9 cases), central bisegmentectomies (3 cases), extended left lobectomies (3 cases) and extended right lobectomy (1 case). The median age was 52 (range, 30-76), and the male:female ratio was 46:11 in the limited resection group. The median tumor size was 3.2 cm, and the median resection margin was 1.2 cm. Limited resections were done in 57 cases, including left lateral segmentectomies (12 cases), right posterior segmentectomies (10 cases), #6 subsegmentectomies (7 cases), left medial segmentectomies (7 cases), right anterior segmentectomies (6 cases), nonanatomical partial hepatectomies (5 cases), #5 #6 subsegmentec-tomies (2 cases), #8 subsegmentectomies (2 cases), caudate lobectomies (2 cases), #5 subsegmentectomies (2 cases), #5 subsegmentectomy caudate lobectomy(1 case), and #2 subsegmentectomy (1 case). The cumulative 5-year survival rate of the two groups was 69%. The cumulative 5-year disease-free survival rate of the major resection group was better than that of the limited resection group (80% vs 53%, p=0.01).
CONCLUSIONS
Problems, including the relatively high recurrence rate after a limited hepatic resection, remain to be solved. It is necessary to perform adjuvant therapy to prevent recurrence in patients receiving a limited hepatic resection. We advocate a major hepatic resection for primary small hepatocellular carcinomas in order to prevent recurrence. Preoperative portal vein embolization can be a good modality in patients who will undergo major hepatic resections.