Purpose: This study examined the effects a partial hepatectomy through an analysis of survival rates and examine the recurrence pattern after a partial hepatic resection for HCC according to the Milan criteria combined with Child-Pugh A cirrhosis.
Methods: On hundred and twenty seven HCC patients with Child-Pugh A liver cirrhosis undergoing a hepatic resection for HCC from September 1987 through July 2004 in the hospital were retrospectively reviewed. Among them, 85 cases met the Milan criteria (M group). However, the remaining 42 cases did not (N group). The median age was 52 years and males outnumbered females by almost five times. The median follow up period was 39.8 months.
Results: No in-hospital mortality occurred in the M group, but there was a single mortality case in the N group. The size of the tumor, multiplicity and major resection rate were different between the two groups. The 5 years overall survival rate of each group was 62.3% and 37.3%, respectively (P=0.002) and the 5 year disease free survival rates were 44.0% and 24.5%, respectively (P=0.023). Forty one patients in the M group developed recurrences, of which 35 had only intrahepatic recurrences. Among them, 28 recurrences still met the Milan criteria.
Conclusion: A partial hepatic resection should be considered a standard treatment method for a HCC meeting the Milan criteria with compensated liver cirrhosis in terms of safety and long-term survival. A salvage transplantation may play a role after a recurrence because most recurrences are intrahepatic recurrences that meet the Milan criteria. (J Korean Surg Soc 2006;71:189-196)
|