Localized anatomical segmental resection for centrally located large hepatocellular carcinoma

Objective To explore the safety and efficacy of localized anatomical segmental resection (LASR) in the treatment of patients with centrally located large hepatocellular carcinoma (HCC). Methods Clinical data of 34 patients with centrally located large HCC underwent LASR in the First Affiliated Hospital of Kunming Medical University between January 2011 and January 2016 were analyzed retrospectively. There were 30 males and 4 females, aged from 36-68 and with a median age of 53 years old. All the patients were with graded A liver function by Child-Pugh Classification, and 31 were complicated with cirrhosis. The informed consents of all patients were obtained and the local ethical committee approval was received. The porta hepatis was dissected first in all patients. The portal vein and left primary and right secondary branches of hepatic artery were suspended respectively. Corresponding vessels were cut off or clamped according to the extent of planned resection, the ischemic line was determined and the liver was resected by ultrasonic scalpel with clamping technique. Results All patients underwent LASR as scheduled, and no perioperative death occurred. The mean length of operation was (233±48) min. The intraoperative blood loss was (304±151) ml. Four patients received blood transfusion during the operation. The postoperative overall incidence of complications was 24%(8/34), including 1 case of liver failure who was cured with conservative treatments. All patients were followed up for 12-60 months, during which recurrence or metastasis occurred in 24 patients. The median disease-free survival time was 29 months, and the 1, 5-year overall survival was 83% and 45%. Conclusions LASR is safe and effective in the treatment of patients with centrally located large HCC, especially for patients with cirrhosis, and it can reduce the incidence of liver failure and operative mortality. Key words: Carcinoma, hepatocellular; Hepatectomy; Liver failure