To discuss the surgical treatment and its effects for hepatocellular carcinoma (HCC) in late pregnancy.

Clinical data of 3 patients with HCC in late pregnancy who were admitted in Department Hepatobiliary Surgery, the First People's Hospital of Foshan from November 2011 to December 2011 were analyzed retrospectively. The age of the patients was 23, 33 and 26 years old respectively. Case 1 with 35 weeks pregnancy was admitted to hospital for 3⁺ weeks of progressive jaundice in skin and sclera after caesarean, and the alpha-fetoproteins (AFP) was 49 096 μg/L. Case 2 with 29⁺⁴ weeks pregnancy was admitted to hospital after 1 week of finding a giant occupying lesion in the right lobe of liver, and the AFP was 973 μg/L. Case 3 with 30⁺⁶ weeks pregnancy was admitted to hospital for 1 month of right upper quadrant abdominal dull pain after 2 d of finding a giant occupying lesion in the right lobe of liver, and the AFP was >1 210 μg/L. The patients who had a history of viral hepatitis B began to take obstetrical examinations from 3⁺ month of pregnancy, but not including the upper abdomen ultrasonic scan. All of them were diagnosed with HCC by ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). The informed consents of 3 patients were obtained and the ethical committee approval was received. Case 1 underwent percutaneous transhepatic cholangial drainage (PTCD) to reduce jaundice, then underwent right hemihepatectomy by anterior approach + thrombectomy through choledochotomy + left hepatic duct-jejunum end-to-side anastomosis. Case 2 delivered a healthy baby girl by caesarean after 2 weeks of conservative treatment, then underwent right hemihepatectomy by anterior approach + hepatic segment Ⅳ nodulectomy. Case 3 delivered a healthy baby boy naturally after 1 week of conservative treatment, then underwent segment Ⅵ,Ⅶ,Ⅷ hepatectomy by anterior approach.

Case 1 recovered well after operation and was found with multiple intrahepatic metastasis in January 2013. Then transcatheter arterial chemoembolization (TACE) was performed. Case 2 was discharged from hospital with improvement 10 d after operation. Multiple hepatic and pulmonary metastasis was found 4 months after operation, and then treatments of targeted therapy of sorafenib combined with local radiofrequency ablation were given to the patient. Case 3 suffered bile leakage, bile duct and right subphrenic infection, and pancreatic tail infection and necrosis after operation and was discharged from hospital with improvement 93 d after treatments of repeated anti-infection, percutaneous peritoneal drainage, enternal nutrition support and so on. And then multiple pulmonary metastasis was found in February 2013. All the patients survived till this article was submitted.

Once the diagnosis of HCC in late pregnancy is confirmed, the patient is suggested to keep pregnant till 32 weeks in order to save baby’s life and undergo hepatectomy as early as possible. Most of the patients are late HCC and the curative effect is poor.