Cancerul hepatocelular (CHC) a devenit a treia cauzã de deces de cancer la nivel mondial, totodatã ciroza hepaticã este principalã cauzã
de dezvoltare a CHC æi are un raport negativ asupra apariåiei bolii æi, de asemenea, complicã foarte mult abordarea chirurgicalã în
tratamentul acestei boli, chiar æi într-un stadiu incipient al dezvoltãrii. Rezecåia chirurgicalã æi transplantul hepatic au devenit metode de
tratament potenåial curative în stadiul incipient. Invazia vascularã, rãspândirea procesului patologic, stadiul cirozei æi rezervele
funcåionale hepatice sunt o componenåã integrantã în selectarea tratamentului optim al acestor pacienåi. Pacienåii cu cirozã Child A æi
hipertensiune portalã, care corespund criteriilor Milano, se presupune cã, transplantul de ficat este metoda optimalã de tratament.
Rezecåia chirurgicalã este pe larg acceptatã ca metoda de prima linie în stadiul încipient cu funcåia hepaticã relativ pãstratã.
Materiale æi metode: Au fost analizaåi 30 de pacienåi cu CHC în stadiul precoce æi intermediar grefat pe cirozã hepaticã Child A, care
au suportat tratament chirurgical æi 4 pacienåi dupã transplant. La toåi s-au determinat marcheri pozitivi de virusul hepatitei B, C, D
în diferite combinaåii. Hepatectomii minore (<3 segmente) s-au efectuat în 53% æi hepatectomii majore în 47%. Dimensiunile tumorii
au fost de la 1,5 cm pînã la 15 cm (cu o medie de 6 cm). Morbiditatea postoperatorie 38 % (n = 12), mortalitatea postoperatorie
6% (n = 2). Rata de supravieåuire globalã la 5 ani a fost de 35%, recidiva CHC a avut loc în proporåie de 84% (70% recidivei locale
æi 26% din manifestãrile extrahepatice ale CHC). Cele mai proaste rezultate au fost observate la pacienåii cu semne clinice de
hipertensiune portalã. Toåi pacienåi care au suferit transplant hepatic sunt fãrã recurenåã detectatã, timpul de observare este de 34,
29, 12 æi 8 luni respectiv.
Concluzii: Tratamentul chirurgical al CHC în stadiu incipient grefat pe cirozã hepaticã contribuie la o ratã de supravieåuire relativ mare,
asigurând în acelaæi timp o bunã calitate a vieåii. Rezultate acceptabile pot fi realizate la unii pacienåi în stadiile intermediare ale CHC,
cu condiåia cirozei compensate în stadiul Child-Pugh A. Prezenåa hipertensiunii portale detectabile clinic afecteazã în mod negativ
rezultatele postoperatorii, cu toate acestea, nu ar trebui sã fie luatã ca o contraindicatie pentru rezectia chirurgicalã. Transplantul de
ficat este operaåia de alegere la aceæti pacienåi, cu condiåia ca aceætea îndeplinesc criteriile Milano.

Hepatocellular cancer (HCC) has become the third leading cause of cancer death worldwide, in the same time liver cirrhosis is the
main cause of HCC development and has a negative impact on the onset of the disease and also complicates the surgical approach
in the treatment of this disease, even at an early stage of development. Surgical resection and liver transplantation have become
potentially curative treatment methods at the early stage. Vascular invasion, the spread of pathological process, the stage of cirrhosis
and hepatic functional reserves are an integral component in selecting the optimal treatment of these patients. In patients with
Child A cirrhosis and portal hypertension meeting the Milano criteria, liver transplantation is the optimal method of treatment.
Surgical resection is widely accepted as a first-line method in the early stage of HCC with relatively appropriate hepatic function.
Materials and Methods: There were analysed 30 patients with early and intermediate stage of HCC which underwent surgical
treatment and 4 patients after transplantation. In all patients were determined positive markers of hepatitis B, C or D in various
combinations. Minor hepatectomies (<3 segments) were performed in 53% and major hepatectomies in 47% of cases. Tumor
dimensions ranged from 1.5 cm to 15 cm (with an average of 6 cm). Postoperative morbidity 38% (n = 12), postoperative
mortality 6% (n = 2). The overall survival rate for 5 years was 35%, HCC relapse occurred in 84% (70% of the local relapse and
26% of the HCC extrahepatic manifestations). The worst results were seen in patients with clinical signs of portal hypertension. All
patients who have undergone liver transplantation have no recurrence detected, the observation time is 34, 29, 12 and 8 months
respectively.
Conclusions: Surgical treatment in early-stage HCC in liver cirrhosis contributes to a relatively high survival rate, in the same time
ensuring a good quality of life. Acceptable results can be achieved in some patients at the intermediate stages of HCC, with the
cirrhosis being compensated in the Child-Pugh stage A. The presence of clinically detectable portal hypertension adversely affects
postoperative outcomes, however, should not be taken as a contraindication for surgical resection. Liver transplantation is the
surgery of choice in these patients, as long as they meet the Milano criteria.