SINGULAR HEPATOCELLULAR-CARCINOMA IN LIVER-CIRRHOSIS - EARLY DIAGNOSIS AND SURGICAL REMOVAL

721 patients with liver cirrhosis were regularly screened by sonography and determination of alpha fetoprotein during a period of eleven years (1.1. 1982-1.1. 1993). In 137 of them hepatocellular carcinoma (HCC) was diagnosed; 28 (20.4 %) had a unilocular HCC with a diameter up to 5 cm. Diagnosis was regularly verified by sonographic guided puncture, in rare cases by laparoscopy and biopsy. Beside a diameter of 5 cm the tumor should be localized at least 5 mm from the main structures in the hilus, and not in the centre of the liver; furthermore multilocular hepatocellular carcinomas and intra- and extrahepatic metastases were contraindications. Child-Pugh-classification should be A + B and urea synthesis rate at least 6 g per day. In 21 patients (75 %) a portal hypertension was diagnosed; 19 (68 %) had bled from esophageal varices; in case of one bleeding a therapeutic sclerotherapy and in case of recurrent variceal hemorrhage an elective shunt operation were performed. Surgical resection was carried out with controlled hypotension and temporary occlusion of the hepatoduodenal ligament. Tumor was removed by segmentectomy or bisegmentectomy and in rare cases by enucleation. There were 3 clinical deaths (10.7 %); causes of death were liver failure and (2) sepsis (1). All patients could be followed up to January 1, 1993; there were 12 further deaths of liver failure, tumor recurrence or second tumor. 13 patients are still living. Thus the live expectancy for one year was 80, for 5 years 50 and for 10 years 30 %. There is no doubt, that it is possible to detect hepatocellular carcinoma in patients with liver cirrhosis early by regular sonography and determination of alpha-fetoprotein. If there is an unilocular tumor not larger than 5 cm in diameter the surgical resection should be performed. Surgical therapy can be performed with low risk and a hospital mortality of 10 %. Live expectancy for one year is 80, for 5 years 50 % and for 10 years 30 % and thus much better than in the majority of other gastrointestinal carcinomas.