The surgical management of hepatoma: a review of 29 hepatic resections

[Liver resections for primary liver malignancies. Personal results and analysis of the literature]

In a retrospective study we analysed 50 resections for primary liver tumors performed between 1 July 1979 and 31 December 1991 at the Department of Surgery of the University of Cologne. The mean resectability rate was 28%. Hospital mortality after resection was 22% and could be reduced to 4% during the last 4 years. The overall survival rates after 1, 3 and 5 years were 55%, 30% and 24% respectively. The surgical radicality is the most important prognostic factor. In a review of the literature the results of 8,725 resections for primary liver malignancies published between 1980 and 1992 were analyzed. The mean resectability rate was 32 +/- 17%. The hospital mortality after resection could be reduced from 15 +/- 5% (resections before 1970) to 6 +/- 2% (resections after 1980). The overall survival rates after 1, 3 and 5 years were 66 +/- 17%, 39 +/- 15% and 27 +/- 10%, respectively. Apart from a lower hospital mortality in Asian studies (4% vs. 7%) the resection rates and long-term results of Asian, American and European studies were similar. Long-term prognosis predominantly depended on the surgical radicality and on the size and extension of the tumor at the point of resection. The effectivity of an adjuvant tumor therapy is not analyzed sufficiently.