Experience with resection of primary hepatic malignancy.

Our experience with hepatic resection for 106 primary hepatic malignancies has been summarized as a part of a total experience with 411 hepatic resections for various indications. The operative mortality rate (death within a month) was 8.5 per cent in treating primary hepatic malignancy, which is significantly higher than that of treating hepatic metastases (0 of 123 resections). Overall operative mortality of 411 hepatic resection was 3.2 per cent. A high operative risk was noted in patients with gross cirrhosis, trauma, abscess, and large malignant tumors. The 1-, 3-, and 5-year survival rates of patients with primary hepatic malignancy were 68.5 per cent, 45.1 per cent, and 31.9 per cent, respectively. Survival rates of patients with fibrolamellar hepatocellular carcinoma were significantly higher than those of patients with nonfibrolamellar hepatocellular carcinoma. Eighteen patients survived more than 5 years after hepatic resection, 14 of whom had been treated by trisegmentectomy. The most extensive partial hepatectomy, such as right and left trisegmentectomy rather than extended lobectomies, should be used to remove massive tumors with adequate tumor-free margins.