Major hepatic resection was carried out on 23 adult patients with hepatocellular carcinoma (HCC) and
underlying cirrhosis of the liver (macronodular in six cases, micronodular in 11, and mixed type cirrhosis
in six). Pre-operative liver functional state was Child's class A in 19, class B in three, and class C in one.
The operations performed were extended right lobectomy in four patients, right lobectomy in 10, left
lobectomy in one, and left lateral segmentectomy in eight. Fifteen postoperative complications were
found in 10 patients, five of whom had duplicated complications and finally died of liver failure 15–65 days
after operation. In three of those five patients, other complications (hemorrhagic shock in two and portal
thrombosis in one) had preceded liver failure. Eighteen patients tolerated the resection and were
discharged from hospital. However, among 13 noncirrhotic patients with HCC who had undergone major
hepatic resection during the same period of time, only two had postoperative complications and all
patients were discharged from hospital. The 1-, 2- and 3-year survival rates in the 23 cirrhotics were
60.9%, 37.5% and 24.9% respectively, whereas the 1–5-year survival rates were all 61.5% in the 13
noncirrhotics. Thus, major hepatic resection may be indicated in selected patients with HCC and
associated cirrhosis, but meticulous managements during and after operation are mandatory to prevent
fatal postoperative liver failure.
The use of neoadjuvant lobar radioembolization prior to major hepatic resection for malignancy results in a low rate of post hepatectomy liver failure
