The authors investigated the clinical and pathological characteristics of 14 cases of hepatocellular carcinoma 3 cm or less in diameter who underwent resectional therapy during the period from April 1985 through May 1994.
All the patients had underlying chronic liver disease. Positivity rates for HBsAg and anti-HCV were 846% and 10%, respectively. Seven cases (50%) were detected during the periodic follow-up of their chronic liver conditions with AFP and
ultrasonography.
Serum AFP level was useful in the diagnosis of small liver cancer. being elevated above 20ng/mL in 78.6% of the patients in the present series. Two tumors, 1.5cm in diameter each, escaped sonographic detection.
All the liver resection were done by anatomic hepatic resection, earlier by so-called systematic subsegmentectomy and currently by extrafascial, Glissonian approach since 1989. to maximally preserve the functional liver tissue while hopefully
ensuring
the radicality of the operation. Nine cases showed expansive growth pattern with formation of tumor capsule, of which 3 had infiltration of the capsule. Infiltrating nature of growth with no capsule-formation was observed in the remaining 5
cases.
Portal vein thrombosis was seen microscopically in 2 cases. Well differentiated, grade I or II lesions according to Edmondson-Steiner classification comprised 73% of the cases. No area or focus of atypical adenomatous hyperplasia was found in any
of the
specimens despite vigorous search for it. Three patients had postoperative complications, one of whom died of multiorgan failure Late death occurred in 3, and 2 of them succumbed to recurrence. Re-resection of the liver for the recurrence was
done
in 2
cases 69 months and 8 months, respectively, after the second resection.
Cumulative overall survival rates at 1, 3 and 5 year were 100%, 1005, and 60%, respectively. Disease-free survival rates at the same time periods were 100%, 68.6%, and 27.4%, respectively
In conclusion, relatively good survival figures were achieved following resection of small liver cancer 3 cm or less in diameter. In view of the frequent recurrence in the hepatic lobe in which the primary tumor was initally located, the widest
possible
anatomic resection, such as resection of one additional adjacent segment, is warranted. For the management of recurrent tumor the aggressive approach of repeat hepatic resection seems to afford the good chance of survival.
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