Surgical Treatment of Hepatocellular Carcinoma

Hepatic resection is currently performed for the treatment of hepatocellular carcinoma (HCC), which is associated with a high incidence of postoperative recurrence. The aim of this study was to clarify the prognostic factors after hepatic resection for HCC. A total of 144 patients who underwent hepatic resection for HCC were studied. Eight factors including albumin, tumor size, intrahepatic metastasis (IM), invasion into the portal vein (Vp), type of hepatectomy, operative time, blood loss, and tumor margin were analyzed with multivariate analysis using a stepwise multivariate logistic regression model to evaluate the prognostic factors after hepatic resection. The relationship between operative procedures and the type of treatment modalities was also investigated, and the outcome of treatment modalities was analyzed using the survival rate after recurrence. Multivariate analysis revealed the type of hepatectomy, Vp, and IM to be independent factors related to recurrence and prognosis. The 5-year survival rate in patients without Vp and without IM was significantly higher than in patients with Vp and with IM (P > .05). The 5-year survival rate and 5-year disease-free survival rate in patients who underwent subsegmentectomy or segmentectomy or lobectomy (anatomic resection) was significantly higher than in patients who underwent partial resection (P > .01 and P > .05). Eleven (31.4%) patients with intrahepatic recurrence after anatomic resection were treated with repeat hepatectomy but only 2 (8.3%) after nonanatomic resection. Moreover, repeat hepatectomy was significantly related to the prognosis after recurrence compared with chemolipiodolization and locoregional chemotherapy (P > .05). These results suggest that anatomic resection, which was related to a low recurrence rate as well as a greater chance of reresection, may be a useful surgical treatment for hepatocellular carcinoma.