Hepatic Resection for Bilobar Hepatocellular Carcinoma

Hypothesis: Patients with bilobar stage IVa hepatocellular carcinoma (HCC) are generally considered unsuitable for hepatic resection. Recent data suggest that palliativehepaticresectioninselectedpatientswithadvanced HCCmayresultinafavorablesurvivaloutcome.Theaim of the present study was to evaluate the operative outcome and survival benefits of hepatic resection for patients with bilobar HCC. Design: Retrospective study. Setting: Tertiary referral center. Patients: The study comprised 78 patients who were diagnosed as having unilobar HCC and considered initially suitable candidates for curative hepatic resection on preoperative investigations from 1989 to 2000. Bilobar disease with discrete tumor nodules in the contralateral lobe was diagnosed in these patients on laparoscopy (44 patients) or laparotomy (34 patients) with the help of intraoperative ultrasonography. Fifteen patients (19%) underwent palliative hepatic resection (group A), and hepatic resection was not performed in the remaining 63 patients (81%) (group B). Main Outcome Measures: The clinicopathologic data and operative and survival outcomes of both groups of patients were compared. Results: The clinicopathologic parameters were comparableinbothgroupsofpatients.IngroupA,12patients(80%) underwentmajorhepaticresection,andthemean±SEMsize oftheresectedtumorswas8.3±0.9cm.Theoperativemorbidityandmortalitywere20%and0%,respectively.Treatment for tumors in the contralateral lobe included wedge excision (5 patients), alcohol injection (5 patients), cryotherapy (2 patients), and transarterial oily chemoembolization(3patients).IngroupB,treatmentforHCCincluded transarterialoilychemoembolization(42patients),systemic chemotherapy(3patients),transarterialoilychemoembolizationandsystemicchemotherapy(5patients),cryotherapy (2 patients), tamoxifen (3 patients), and no treatment (8 patients). The median survival of patients in group A was 19.5months,with4patientssurvivingformorethan3years. ThesurvivalingroupAwassignificantlybetterthaningroup B (median=7.1 months; P=.008). On multivariate analysis,hepaticresectionandpreoperativeserum-fetoprotein level were the 2 independent factors that significantly affected patient survival. Conclusions:HepaticresectionforHCCinpatientswith stage IVa bilobar disease results in a better survival outcome than nonresectional therapies. It should be considered in selected patients with low operative risks and satisfactory liver function.