Perioperative and long-term outcome of major hepatic resection for small solitary hepatocellular carcinoma in patients with cirrhosis

Hypothesis: Major hepatic resection is safe and provides favorable long-term survival for cirrhotic patients with a small solitary hepatocellular carcinoma. Design: Retrospective case series. Setting: Tertiary referral center. Patients: From January 1, 1989, to December 31, 2001, 218 cirrhotic patients with a solitary hepatocellular carcinoma 5 cm or less in diameter underwent either a major hepatic resection (n=84) or a minor hepatic resection (n=134). Major Outcome Measures: Perioperative morbidity and mortality, and long-term survival rates. Results: The major resection group had significantly larger tumors (median, 3.5 vs 2.5 cm; P<.001) and better liver function (median indocyanine green retention at 15 minutes, 9.3% vs 12.9%; P<.001) than the minor resection group. Postoperative morbidity (46.4% vs 39.6%) and mortality (8.3% vs 3.0%) were higher in the major resection group than in the minor resection group, but the differences did not reach statistical significance (P=.32 and P=.11, respectively). The median overall survival did not differ significantly between the 2 groups (102.0 vs 72.3 months; P=.25). However, the median disease-free survival in the major resection group was significantly better than that in the minor resection group (59.0 vs 29.5 months; P=.03). On further subgroup analysis both disease-free and overall survival rates were significantly better in the major hepatic resection group for tumors of 3 to 5 cm. Conclusion: In well-selected cirrhotic patients with a small, solitary hepatocellular carcinoma, major hepatic resection is safe and may offer a better long-term survival over minor hepatic resection for patients with tumors of 3 to 5 cm.