Outcome of Liver Resections for Centrally Located Hepatocellular Carcinomas

Jung, Dong Hwan; Hwang, Shin; Lee, Sung Gyu; Kim, Ki Hun; An, Chul Soo; Lee, Young Joo; Park, Kwang Min; Moon, Deok Bog; Ha, Tae Yong

Abstract

PURPOSE: The aim of this study is to determine the prognosis after surgical resection for centrally located hepatocellular carcinoma (HCC) and to analyze the safety and effectiveness of systematic central hepatectomies for treating centrally located HCC.
METHODS
A retrospective study was performed on 130 patients who suffered with centrally located HCC and who underwent liver resection from January 1998 to December 2002. These patients were divided into 3 groups according to the extent of hepatic resection; central hepatectomy group (n=42, 32.3%), hemihepatectomy group (n=19, 14.6%) and partial hepatectomy group (n=69, 53.1%).
RESULTS
There were 108 males and their mean age was 52 years. There were no differences in demographic and clinical characteristics among 3 groups. The tumor size was smallest and the operation time was shortest in partial hepatectomy group. The widest resection margin was obtained in hemihepatectomy group. Transfusion was most frequently required in central hepatectomy group. Postoperative complication occurred in 23 patients(17.7%) and 1(8%) patient succumbed to in-hospital mortality. The overall 1, 3 and 5-year survival rates were 95.4%, 79.0%, and 70.0%, respectively. Disease-free 1, 3, and 5-year survival rates were 77.3%, 57.6% and 43.1%, respectively. Multivariate analysis revealed that anti-hepatitis C antibody, ICG R15, microvascular invasion, tumor stage and morbidity were risk factors for patient survival, whereas anti-hepatitis C antibody, total bilirubin level, ICG R15, tumor size, resection margin and tumor stage were risk factors for disease-free survival. There were no differences in the overall 5-year survival and disease-free survival rates among 3 groups.
CONCLUSIONS
Although central hepatectomy for treating centrally located HCC appeared to be technically difficult, it showed a favorable outcome that was comparable to that of other liver resection groups. When centrally located HCC patients have a limited hepatic functional reserve, parenchymal-sparing central hepatectomy can be safely applied for performing systematic curative resection.