This study evaluated the outcomes of limited hepatic resection versus anatomical resection for hepatocellular carcinoma (HCC) patients. Twenty-nine HCC patients with cirrhosis underwent either anatomical resection requiring hepatic mobilization (Group A, n=16) or limited resection without mobilization (Group B, n=13). Group B had significantly less blood loss and lower postoperative morbidity rates, especially ascites, compared to Group A. However, the 3-year and 5-year survival rates were similar between groups. The study concluded that limited hepatic resection with minimal mobilization is preferred over anatomical resection for HCC patients with cirrhosis, as it reduces postoperative morbidity without compromising survival.

1. 12/27/2013
FOUAD[NCI]

2. INTRODUCTION
• Hepatocellular carcinoma (HCC) is the fifth
most common cancer.
• The third leading cause of cancer death
worldwide.
• Surgical treatment is an effective treatment
for HCC.
12/27/2013
FOUAD[NCI]

3. THE AIM OF THE THIS
STUDY
• We aimed to evaluate if
• Limited hepatic ligaments dissection and
• Limited hepatic volume resection
Decreased risk of operative and post operative
morbidity , mortality and hospital stay.
12/27/2013
FOUAD[NCI]

4. METHODS
• Data of twenty nine patients with HCC on
a background of cirrhosis were studied
during the period from January 2002, to
December 2009.
• Patients were operated upon in the
department of surgical oncology in the
National Cancer Institute Cairo University.
12/27/2013
FOUAD[NCI]

5. METHODS
• Group (A) included sixteen patients in
whom wide anatomical hepatic resection of
more than one hepatic segments done and
needed hepatic mobilization.
• Group (B) included thirteen patients who
underwent limited hepatic resection inform
of resection of the lesion regardless of
segmental or lobar anatomy and did not
need hepatic mobilization.
12/27/2013
FOUAD[NCI]

6. • ELIGIBILITY CRITERIA for patient
inclusion in the study were: Patients
selected with a single tumor 5 cm or smaller
and two tumors each 3 cm or less.
• EXCLUSION CRITERIA :Extra hepatic
metastases, and inferior vena cava or main
portal vein tumor thrombus precluded
curative hepatic resection.
12/27/2013
FOUAD[NCI]

7. TECHNIQUE
• Anatomical resection: was defined as the
systematic removal of a hepatic segment
confined
by
cancer-bearing
portal
tributaries and needed hepatic mobilization
in which resection of more than one
Couinaud segments.
12/27/2013
FOUAD[NCI]

8. COUINAUD SEGMENTS
12/27/2013
FOUAD[NCI]

9. TECHNIQUE
• Limited non anatomical resection was
defined as the resection of a lesion
regardless of segmental or lobar anatomy
without hepatic mobilization.
12/27/2013
FOUAD[NCI]

10. 12/27/2013
FOUAD[NCI]

11. 12/27/2013
FOUAD[NCI]

12. Clinicopathological and
surgical data for 29 HCC
patients
Variable
Age Years (mean±SD)
Sex(M:F)
Hepatitis c virus
Child-Pugh score
Liver cirrhosis
Present/absent
Tumor size cm (mean
± SD)
Group(A)
Anatomical
resection+ hepatic
mobilization
(NO.=16)
56±13
11:5
100%
5.7±o.5
16/0
Group(B)
Limited nonanatomical resection
(NO.=13)
P value
61±11
9:4
100%
6.1 ±o.4
13/0
0.2802
5.1 ± 0.9
4.7 ± 1.1
0.2906
630±o213
0.5771
a-fetoprotein (ng/ml) 590±150
± SD
12/27/2013
FOUAD[NCI]
0.312
0.1271
1.000

13. Operative data of hepatic
resection for 29 HCC patients
Variable
Group(A)
Anatomical
resection+
hepatic
mobilization
(NO.=16)
Operative time 113.3±38.4
(min.)
253±87.3
Blood loss
(mean ± SD) ml
Hepatic
(16/16)%
ligaments
cutting
(yes/no)%
8.3 ± 5.9
Surgical
margin mm
(mean ± SD)
12/27/2013
Group(B)
Limited nonanatomical
resection
(NO.=13)
P value
107.8±31.7
0.6504
145.1±25
0.0002
0.005
1/13
7.4 ± 5.4
FOUAD[NCI]
0.6748

14. Post operative mortality and
morbidity for 29 HCC patients
Variable
Mean hospital stay(days)
Operative mortality (one
month death)
Postoperative
Morbidity(total)
Bleeding
Jaundice
Ascites
 Mild
 Moderate
 Severe
 Encysted ascites
12/27/2013
Group(A)
Anatomical
resection+ hepatic
mobilization
(NO.=16)
7±6.3
Group(B)
Limited nonanatomical
resection
(NO.=13)
3±2.4
P value
1/16(6.5%)
0/13%
0.567
10/16(62.5%)
1/13(7.5%)
0.036
1/16
1/16
8/16
4/16
2/16
1/6
1/16
0 /13
0/13
1/13
1/13
0/13
0/13
0/13
FOUAD[NCI]
0.0399

15. Kaplan-Meier survival curve
for 29 patients with HCC
100
80
60
GROUP
A
B
40
20
P = 0.9291
0
0
10
20
30
40
50
60
70
Time
The overall survival 3-years and 5-years survival in: group A patients was 68% ;39%
and in group B was 65%; 33%.
12/27/2013
FOUAD[NCI]

16. CONCLUSIONS
• Surgical treatment of HCCs, the balance
between curability and hepatic function
preservation is important.
• Limited liver resection with limited
mobilization is the preferred technique
for HCC in cirrhotic patients.
• Anatomical resection with hepatic
mobilization did not improve the overall
survival compared with limited hepatic
resection.
12/27/2013
FOUAD[NCI]

17. CONCLUSIONS
• Increased risk of operative morbidity
were identified in patients who had,
resection of :
• A large volume of functioning liver parenchyma
• Extensive hepatic mobilization and dissection of the
hepatic ligaments
increase post operative
morbidity especially ascites due to increase
lymphatic
transudation
;
increase
portal
hypertension.
12/27/2013
FOUAD[NCI]

18. 12/27/2013
FOUAD[NCI]