To evaluate the safety, feasibility and therapeutic outcome of surgical resection for centrally located hepatocellular carcinoma(HCC).

A total of 35 cases diagnosed as centrally located HCC were enrolled in this retrospective study, who underwent operations from January 2007 to December 2011 at the Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. The patients included 31 males and 4 females with median age of 64 years old (range: 25-69 years old). Among three patients with HCC located in Couinaud segments Ⅳ and Ⅴ, 2 cases received left hemihepatoectomy and 1 case received local resection. Among 11 patients with HCC located in Couinaud segments Ⅷ, 7 cases underwent hepatic segmentectomy of Ⅷ and the other 4 cases underwent hepatic segmentectomy of Ⅶ and Ⅷ. Among seven patients with HCC located between the right anterior and posterior branch of portal vein, 4 cases received hepatic segmentectomy of Ⅴ and Ⅵ and 3 cases received right hemihepatoectomy plus embolectomy. Two patients had HCC located between the left and right trunk of portal vein, the middle and right hepatic vein, inferior vena cava (IVC). These two cases received local resection and one of them underwent right and left liver split following resection. Among seven patients with HCC located in apical segment of IVC, 2 cases received hepatic segmentectomy of Ⅵ and Ⅶ, 2 cases received hepatic segmentectomy of Ⅶ and Ⅷ and the other 3 cases received hepatic segmentectomy of Ⅴ and Ⅵ. The volume of intraoperative blood loss and transfusion, operation time, blood loss control, intraoperative and postoperative complications as well as mortality were observed and recorded. All the patients were followed up and Lift Table method was applied to calculate the survival rate.

All the 35 HCC patients received successful operations and no operative mortality was observed. No complications were observed such as air embolism and massive haemorrhage caused by IVC or rupture of hepatic vein. The intraoperative blood loss were 100-600 ml with the median volume of 280 ml and 5 cases received 2-4 U blood transfusion. The operating time was 135-265 min with the median time of 178 min. The blood loss control methods included 26 cases undergoing the first hepatic portal control (1-2 times hepatic occlusion with time of 15-35 minutes, median time of 24 minutes), 2 cases undergoing left hepatic portal control (olny one-time hepatic occlusion with time of 10, 15 minutes respectively), 4 cases undergoing the right hepatic portal control (2 times of occlusion with time of 20-38 minutes, median time of 28 minutes). The other 3 cases with right hemihepatoectomy had right branch of hepatic artery cut off and the right branch of portal vein blocked up. Four of the 35 patients received total hepatic vascular exclusion with the inferior vena cava blocking time 10-18(13) min for just once. The postoperative complications included 1 case with bile leakage, 4 cases with subdiaphragmatic effusion and 6 cases with right pleural effusion. All patients with complications were cured without haemorrhage and infections. The 1- and 3-year survival rates were 87.8% and 63.0% respectively.

Surgical resection is safe and effective for centrally located HCC. Appropriate techniques and blood loss control should be applied during the operation.