Department of Surgery, University of Manitoba, Winnipeg.
Title
Hepatic resection in patients with cirrhosis and
hepatocellular carcinoma.
Source
Surg Gynecol Obstet 1992 Mar;174(3):245-254
Abstract
Hepatic resection can be performed safely in carefully selected patients
with cirrhosis. To minimize morbidity and mortality, it is essential to
reliably estimate functional hepatic reserve and the extent of tumor before
resection is performed. Child's classification is a reliable predictor of long
term survival, but a more sensitive measure of hepatic function is needed
to predict early morbidity and mortality. Child's classification can also be
used to stratify patients and exclude those at high risk from hepatic
resection. Promising predictors of operative mortality focus on the
mitochondrial function of hepatocytes and include cytochrome a (+a3)
contents and the redox tolerance index. Patients with advanced cirrhosis
are not candidates for extensive hepatic resection and require careful
evaluation before consideration for any hepatic resection. In patients with
well-compensated cirrhosis and unifocal tumors, the procedure of choice
is an anatomic resection of the tumor. If tumor size and location allows, a
segmentectomy offers the best outcome, minimizing postoperative liver
dysfunction while offering a long term outcome not dissimilar to a major
liver resection. In highly selected patients with incidental tumors, a central
tumor and perhaps in patients with multifocal hepatocellular carcinoma,
hepatic transplantation may be of benefit. By using the appropriate
predictors of hepatic function, refined surgical techniques and optimal
postoperative care, a mortality rate of less than 10 per cent is achievable
in cirrhotic patients with hepatocellular carcinoma who require resection.