1991 Volume 24 Issue 8 Pages 2231-2235
Recent progress in detecting early hepatocellular carcinoma (HCC) has increased the number of patients who undergo hepatectomy. The incidence of postoperative recurrence from a remnant, however, has also increased, and the prognosis may be altered by prophylactic measures. This is a report of a 55-year-old male patient who received three supplemental resections. Left hepatic lobectomy was carried out for liver-cirrhosis-complicated HCC extending over S2 to S4. About 15 months later, a second hepatic resection was performed for tumor recurrence in S6. Seventeen months after the second resection, a third resection on S7 and S8 by thoracolaparotomy was performed, and a fourth resection on S6 was carried out 10 months later. At present, 5 years and 7 months after the first hepatectomy, the patient is well without any symptoms of tumor recurrence. Thorough follow-ups by not only serum a-fetoprotein determination but also ultrasonography and computed tomography after the first operation are very necessary for those patients with liver cirrhosis as an underlying disorder, as there is a high incidence of tumor recurrence. Supplemental resection can be performed only when the liver function is comparatively unchanged from the function at the first operation, because extensive bleeding i expected in the process of denuding the sites of adherence. Therefore, careful denudation, and acquisition of a wide operative filed should be achieved. A transphrenic approach through thoracotomy, as in this case, is often useful.
