Significance of systematic subsegmentectomy of the liver for hepatocellular carcinoma from the view point of the long-term result

Abstract

We have performed subsegmentectomies for hepatocellular carcinomas (HCC) in cirrhosis using ultra-sonic examination, considering intra-hepatic extension of HCC via the portal vein. Hepatectomized cases were divided into three groups by the operative procedure undergone: Non-anatomical partial resection (Group A, n=179), anatomical subsegmentectomy (Group B, n=117) and anatomical resection more than one segment (Group C, n=127). Cases with highly injured liver function were significantly more in Group A than other two, however, the grades of cancer extension in the three group were almost same. The 5-year survival rates were 45.1% in Group A and 48.3% in B. Those suggest that factors such as 1) even in small HCC indicated for small range resection, such as partial resection or subsegmentectomy, occult intrahepatic metastases are beyond the subsegment, 2) presence of multicentric carcinogenesis in cirrhosis and 3) how the effect of treatment for recurrences is, are stronger than the operative procedure, non-anatomical or anatomical.