[Hepatectomy for hepatocarcinoma on a cirrhotic liver: decision plans and principles of perioperative resuscitation. Experience with 204 cases].

Abstract

Among more than 450 hepatectomies performed in the National Cancer Center Hospital of Tokyo from the beginning of 1977 to the end of 1986, 204 were performed for excision of an hepatocarcinoma on cirrhotic liver. The post-operative mortality (determined until the exit of the patient out of the hospital) was 7.8%. It was rather high at the beginning (20% of the first 30 cases) and progressively decreased with experience, to be only 2.8% of the last 70 cases. According to this experience the authors recommend a decisional diagram which appreciate the quantity of functional liver parenchyma which must be resected (depending on the tumor's characteristics) and the quantity of functional liver parenchyma which can be resected without major operative risk (depending on the gravity of the cirrhosis). They expose their attitude with oesophageal varix, the operative techniques and the peri-operative cares they have trained to decrease dramatically the post-operative complications.