Is hepatic resection absolutely contraindicated for hepatocellular carcinoma in Child-Pugh class C cirrhotic patients?

BACKGROUND/AIMS: Liver resection for hepatocellular carcinoma (HCC) in Child-Pugh class C cirrhotic patients is considered to be high risk and even contraindicated. This study examined our results of hepatectomy for HCC in such cirrhotic patients. METHODOLOGY: A retrospective review of the clinicopathological features, as well as early and late resection results of Child-Pugh class A (n=181) and class C patients (n=13) were compared. The extent of hepatectomy was based on the pre-operative liver function test and indocyanine-green (ICG) clearance rate. RESULTS: The tumor size in class C patients was smaller than that in class A patients. There were no significant differences with regard to operative blood loss, amount of blood transfusion, operative morbidity or mortality. The surgical margins of class C patients were narrower (p=0.003). The tumors of class C patients had higher incidences of well-formed capsules and absence of satellite nodules. The 5-year disease-free and actuarial survival rates of class A and C patients were 35.4% and 40.7% (p=0.28), and 48% and 50% (p=0.13), respectively. CONCLUSIONS: Not all HCCs in Child-Pugh class C cirrhotic patients are contraindicated for liver resection. In the absence of uncontrollable ascites, marked jaundice and encephalopathy, surgical resection is still justified in some selected cases, in spite of a narrow surgical margin.