Surgical treatment of hepatocellular carcinoma associated with spontaneous portosystemic shunts

Abstract

Objective: To clarify the short and long term prognosis after hepatectomy and shunt ligation in patients with hepatocellular carcinoma (HCC) and spontaneous portosystemic (P-S) shunts. Design: Retrospective study. Setting: University hospital, Japan. Subjects: Fourteen patients with HCC and a P-S shunt. Interventions: Hepatic resection (radical in 12 and palliative in 2 patients) and ligation of the shunt; 12 also had prophylactic operations for oesophagogastric varices. Main outcome measures: Morbidity, mortality, hepatic function, and survival. Results: Serum ammonia concentrations fell after operation and stayed low throughout the postoperative period. Though prothrombin time and serum antithrombin-III concentrations deteriorated for one month after operation, they gradually returned to the preoperative values. Serum albumin did not change throughout the follow up period. Serum bilirubin concentrations were reduced postoperatively in 10 patients. Results of indocyanine green and Bromsulphalein retention tests were similar before and one month after operation. Child's grade improved in four patients within a year. At 1, 3, and 5 years 10, 5, and 3 patients were alive, and 10, 4, and 1 of these were free of disease. No patients ruptured their oesophagogastric varices during the follow up period. Conclusions: Simultaneous ligation of spontaneous P-S shunts makes hepatic resection safe and produces unexpectedly good survival in patients with HCC and the severe cirrhosis associated with such shunts.