Long term results after US-guided liver anatomical resections for hepatoma in cirrhosis

In the last few years several US-guided surgical procedures for treatment of HCC were assessed. In particular, anatomical liver resections like segmentectomies and subsegmentectomies with injection of dye in the portal branches with tattooing of parenchyma showed long term better results when compared to wedge resections in treatment of small HCC, where more extended operations were not advisable if cirrhosis coexists. The result of this type of echo-guided procedures in our experience are here reported. 31 segmental liver resections for small HCC in 22 (20 M, 2 F) cirrhotic patients (21 A, 1 B Child's class), mean age 63 (43-73) were carried out. In all patients intraoperative ultrasonography indicated the location of the lesions and the transection planes of parenchyma to obtain the entire removal of the portal unit. 12 procedures (9 patients) were conducted with metylen blue injection into the portal pedicle under vascular occlusion according to the technique of `systematic subsegmentectomy'. The resected hepatic segments were 1-3, average 1,4. 31% had minor complications, and perioperative mortality was 9%. The disease-free survival was 6-96 months (mean 25). The overall 1 year actuarial survival rate was 95%, at 3 years 80% and at 5 years 75% (according to Kaplan-Meyer method). US-guided anatomical liver resections can ensure a promising long term survival with an acceptable percentage of postoperative complications.