Results of Hepatectomy as First Treatment for Hepatocellular Carcinoma within the Milan Criteria with Preserved Liver Function

Purpose: Hepatic resection and liver transplantation are surgical therapeutic options for small-sized HCC. But, the therapeutic option for patients meeting the Milan criteria with preserved liver function is facing a dilemma. In this study, we examined the outcomes of surgical resection for HCC patients meeting the Milan criteria with preserved liver function and rationale of hepatic resection as the first treatment for HCC meeting the Milan Criteria. Methods: Between 1991 and 2006, 248 patients with HCC underwent hepatectomy in 158 primary HCC patients meeting Milan criteria (Group M) and in 90 patients beyond Milan criteria (Group N). Median age was 54.5 years in group M and 52.4 years in group N. Results: The tumor size, mean survival months, E-S grade and vascular invasion rate were significantly different between the two groups. 67 patients in group M and 22 patients in group N had intrahepatic recurrence after primary hepatectomy. The cumulative 1, 3, and 5-year survival rates were 91.9%, 74.5%, and 60.5% in intrahepatic recurrence group M after primary hepatectomy and 100%, 96.0%, and 90.5% in repeated hepatic resection for recurrent treatment in group M, respectively. Conclusion: Because of the high survival rate and long-term survival after adequate treatment of recurrence, primary hepatectomy is considered a reasonable option as first-line treatment for HCC meeting Milan criteria with preserved liver function. (J Korean Surg Soc 2009;77:267-272)