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10.1245/s10434-008-9880-7
Annals of Surgical Oncology 15:1670-1676 (2008)
© 2008 Society of Surgical Oncology
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Original Article

Short- and Long-Term Outcomes after Hepatic Resection for Hepatocellular Carcinoma with Concomitant Esophageal Varices in Patients with Cirrhosis

Yuichiro Kawano, MD1,2, Atsushi Sasaki, MD1,2, Seiichiro Kai, MD2, Yuichi Endo, MD2, Kentaro Iwaki, MD2, Hiroki Uchida, MD2, Kohei Shibata, MD2, Masayuki Ohta, MD2 and Seigo Kitano, MD2

1 Department of Surgery, National Hospital Organization Miyazaki Hospital, 19403-4 Kawaminami-machi, Miyazaki 889-1301, Japan
2 Department of Surgery I, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan

Correspondence: Address correspondence and reprint requests to: Atsushi Sasaki, MD; E-mail: sasakia{at}med.oita-u.ac.jp

Background: Hepatic resection for hepatocellular carcinoma (HCC) in cirrhotic patients with esophageal varices (EV) is often avoided because of poor liver function reserve. Outcomes of resection in such cases have not been fully investigated.

Methods: We conducted a retrospective study of 134 cirrhotic patients (Child–Pugh class A or B) who underwent hepatic resection for HCC, comparing short- and long-term outcomes in patients with EV (n = 31) to those in patients without EV (n = 103).

Results: Patients with EV had higher tumor differentiation, fewer instances of portal invasion, lower liver function reserve, and more limited resections than did patients without EV. Of 31 patients with EV, four died of postoperative complication, and nine of liver failure, seven of HCC, two of ruptured EV, and two of other causes. Median survival time for patients who died of liver failure was 59 months. Mortality and morbidity rates after hepatic resection did not differ between patients with and without EV. The 5-year overall survival rate was significantly higher in patients with EV (70.1%) than in those without EV (47.5%, P = 0.045) but did not differ between patients without portal invasion with and without EV (P = 0.55). Presence of EV was not an independent predictor for survival.

Conclusions: Short- and long-term outcomes of hepatic resection in HCC patients with and without EV are similar. Limited hepatic resection for early-stage tumor is an option for Child–Pugh class A or B patients with EV.

Key Words: Hepatocellular carcinoma • Esophageal varices • Hepatic resection • Liver cirrhosis • Prognosis






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