Surgery for Primary Hepatocellular Carcinoma

The question of the choice of surgical tactics in patients with Hepatocellular cancer remains extremely controversial. The most frequent intervention in primary liver cancer are hemihepatectomies. Segmentectomy and atypical resections are performed less frequently. However, several data resulting surgical treatment of hepatic cancer suggest that extensive resections of the liver do not always improve long-term results of treatment and are associated with a high frequency of complications and postoperative mortality.
A special place in the surgical hepatology occupied by patients with concomitant liver cirrhosis. Some authors believe that practice of surgery in such cases ( N.Lee et al. , 1982), however, this opinion should be considered as obsolete. However, most experts warn against extensive resections of the liver in the oppression of liver function against the background of cirrhosis and believe that резецировано may be no more than 25% of the parenchyma ( D. Franco et al., 1998, S. Little et al., 2001) . As I see this problem, I prefer extensive resections. My opinion is based on biological characteristics of this tumor, high probability of tumor satellites and also morphological characteristics. Peripheral primary hepatic tumors are very rare, and in most of the cases atypical resections and segmentectomies are impossible and cannot be radical.


2 weeks ago patient with primary liver cancer applied to our clinic. . Hepatocellular cancer ( AFP - 3865), on the background of associated B-hepatitis and morphologically proven cirrhosis of the liver was diagnosed. At the preoperative stage we found ascites (200 ml), thrombocytopenia, 126 , albumin level - 30 g/l . Pain syndrome was the main complaint, which was due to the growth of the tumor in the diaphragm, which required the appointment of strong painkillers. Despite the large size of the tumor, the biggest part was located outside the liver.
I would like to share with you this interesting clinical supervision. Such distribution of primary liver cancer is uncommon. During the operation it was revealed that the tumor consisted of two components. Hepatic section was located peripherally in S8 and amounted to 2,0-2,5 cm in diameter. Extrahepatic component was about 7-8 sm.

I am a supporter of radical surgery in any cases and technically hemihepatectomy could be performed without problems. However, in this clinical situation, taking into account the condition of the patient ( cirrhosis and B-hepatitis, Child -- Plug B ) , we have decided to implement the economical resection and resection of the diaphragm. I am very interested in your opinion about our tactics. Waiting for comments.

Video by Ilya Gotsadze (M.D., Ph.D.)