[Resections of hepatocellular carcinomas in cirrhosis: results of a prospective study of 28 resections].

Twenty-eight liver resections were performed in 24 patients with cirrhosis and hepatocellular carcinoma: 6 major hepatectomies, 13 limited, and 9 atypical liver resections. Postoperative variceal rebleeding was precluded in 5 patients with previous bleeding by preoperative sclerotherapy. Intraoperative bleeding was minimized in 16 patients by clamping the hepatic pedicle. Ascites formation was prevented by reduction of intraoperative and postoperative fluid infusion. There were no operative deaths. Benign postoperative complications occurred in 5 patients (18 p. 100). In one patient, carcinoma was not found in the resected specimen. Nineteen of the 27 others tumors were less than 5 cm in diameter (70 p. 100). Twenty-two tumors were encapsulated (81 p. 100). One and two-year actuarial survival rates were 66 p. 100 and 48 p. 100 in the group of 23 patients after resection of one, or more than one tumor, respectively. In 17 patients with a tumor less than 5 cm in diameter, one and two-year survivals were 76 p 100 and 51 p. 100, respectively. In 16 patients with a free margin of healthy tissue of more than 10 mm, one and two-year survivals were 85 p. 100 and 61 p. 100 respectively. Our results suggest that: 1) the operative risk of liver resection in cirrhosis is low, provided preventive measures are taken to avoid intraoperative bleeding and postoperative variceal bleeding and ascites, and 2) late survival is good in selected groups of patients after resection of hepatocellular carcinoma and cirrhosis.