Abstract
In our hospital, as of December 1993, radical hepatic resections had been performed in 82 patients with small hepatocellular carcinoma (HCC) 2cm or smaller. Bisegmentectomy was done in 8 patients, segmentectomy in 11, subsegmentectomy in 20, and partial resection in 43. When the results of preoperative liver function tests were satisfactory, a large-scale operation was generally possible, but in decisions about the scale of the operation, the intraoperative appearance and findings from palpation of the liver were more important than preopeartive findings. There were recurences in 39 patients. The survival rate and tumor-free survival rate were better after bisegmentectomy than after smaller scale operations. If the scale of surgery had been decided according to preoperative liver function, 12 patients of the 74 who did not in fact undergo bisegmentectomy could have been selected for bisegmentectomy. However, in these 12 patients, only two had recurrences. If bisegmentectomy had been done for all patients, then of the 37 cases of recurrence among the 74 patients who did not undergo bisegmentectomy, seven could have been prevented (the recurrence was within the part of the liver that would have been resected). However, because of liver dysfunction, six of these seven patients could not have withstood bisegmentectomy. Our selection of the scale for resection of small HCC on the basis of results of liver function tests, intraoperative inspection, and palpation of the liver was suitable except for one patient.
