Surgical treatment of hepatocellular carcinomas in noncirrhotic liver: experience with 68 liver resections
Hepatocellular carcinoma (HCC), although generally associated with cirrhosis, can also develop in a noncirrhotic liver. To study HCCs in noncirrhotic liver, their surgical management and prognosis, 68 patients with partial hepatectomy for this disease were analyzed. The liver, in all cases, appeared normal macroscopically at laparotomy, but in 13 cases (19%) it presented some slight histologic modifications, such as steatosis or portal fibrosis. Five patients had a fibrolamellar carcinoma. The mean diameter of the tumors was 8.8 cm. Sixteen patients (23.5%) were treated preoperatively by embolization or chemoembolization. Surgical procedures consisted in a major hepatectomy (three segments or more) in 72% of the cases. Operative mortality and morbidity were, respectively, 2.9% and 19.0%. The 1-, 3-, 5-, and 10-year survivals and the survivals without recurrence were 74%, 52%, 40%, and 26% and 69%, 43%, 33%, and 19%, respectively. Recurrence, which was in most cases intrahepatic, occurred in 39 of the 66 survivors (59%) and was treated by rehepatectomy in 12 cases, providing long survivals. These data justify extensive, aggressive surgery for HCCs in noncirrhotic liver and show the need for long-term follow-up to detect late recurrence, as surgery for recurrent disease prolongs survival.