Factors affecting survival and long-term outcome in the cirrhotic patient undergoing hepatic resection for hepatocellular carcinoma

Aims: Prognostic analysis of hepatocellular carcinoma (HCC) in the cirrhotic patient undergoing hepatic resection is necessary in order to determine the clinical effect of hepatectomy on prognosis. Patients and methods: Univariate and multivariate retrospective analyses were performed in 51 cirrhotic patients (38 men, 13 women; mean age 65 years, range 43-81 years) with supervening HCC undergoing hepatic resection between January 1993 and December 1997. Results: Segmental liver resection was performed in 39 patients (76%) with non-anatomical (wedge) resections in the remainder of cases. The post-operative mortality rate was 8%. The tumours recurred in 23 patients (45%), with 12 patients (52% of recurrences) recurring within 1 year of surgery and 22 patients (96% of recurrences) within 3 years. Recurrent disease was most frequently intrahepatic (22 patients). Significant risk factors for recurrence were micro/ macro vascular invasion, and symptoms. Conclusions: The recurrence rate of hepatocellular carcinoma in patients with cirrhosis undergoing surgical resection alone is high and actuarial survival at 4 years is low. Other approaches to the treatment of hepatocellular carcinoma in patients with cirrhosis require consideration. (C) 2000 Harcourt Publishers Ltd.