Surgical strategy for primary hepatocellular carcinoma associated with cirrhosis

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Abstract
We evaluated the applicability of limited hepatic resection in cases of hepatocellular carcinoma (HCC) in cirrhotic patients. According to the severity of impaired hepatocellular function, 37 patients underwent limited resection, and for 13, standard major hepatic resection was done. There were no significant differences in the mortality and survival rates between the two groups. This limited resection can be selectively used to treat cancer associated with cirrhosis and encapsulated tumors For further evaluation of this limited procedure, an attempt was made to elucidate the manner in which the surgical margin is linked to a recurrence after curative resection for hepatocellular carcinoma in patients with cirrhosis. Forty patients were divided into two groups; those in whom the margin from the cut surface to HCC in the fresh specimen was less than 10 mm wide [TW( + )] and patients in whom the surgical margin was equal to or exceeded 10 mm [TW( − )]. There were 24 and 16 patients in the TW( + ) and TW( − ) groups, respectively. There was no statistically significant difference in the rate of recurrence between the two groups. In patients with a tumor less than 4 cm in diameter, the extent of TW is not linked to an early recurrence. However, when the tumor size exceeds 4 cm, 10 mm of TW is inadequate to achieve curability. When a wide resection is not feasible, then adjuvant therapy should be aggressive.