Less than 20% of hepatocellular carcinoma (HCC) develops in the non-cirrhotic liver (NCL). The diagnosis of HCC in NCL is suggested by a large hypervascular tumor in a 60-75 year old patient (usually male), particularly if the alpha-fetoprotein (AFP) level is high. But AFP is normal more often than not. Surgical resection is the only curative therapy of HCC; resection is more commonly feasible in HCC in NCL due to the healthy parenchyma of the underlying liver. The prognosis of HCC in NCL is better than that for HCC on cirrhosis with a 5-year survival approaching 50%. Prognosis is best in the patient with a small HCC with no vascular invasion or satellite nodules for whom an R0 resection can be achieved without the need for intra-operative transfusion. While intra-hepatic recurrence occurs frequently, it should be aggressively sought and treated; there is a major role for repeat hepatic resection and a lesser role for hepatic transplantation where results are poorer than those obtained for HCC on cirrhosis.

Backgrounds. Pyogenic liver abscess is a rare disease whose management has shifted toward greater use of percutaneous drainage. Surgery still plays a role in treatment, but its indications are not clear. Method. We conducted a retrospective study of pyogenic abscess cases admitted to our university hospital between 1999 and 2010 and assessed the factors potentially associated with surgical treatment versus medical treatment alone. Results. In total, 103 liver abscess patients were treated at our center. The mortality was 9%. The main symptoms were fever and abdominal pain. All of the patients had CRP > 6 g/dL. Sixty-nine patients had a unique abscess. Seventeen patients were treated with antibiotics alone and 57 with percutaneous drainage and antibiotics. Twenty-seven patients who were treated with percutaneous techniques required surgery, and 29 patients initially received it. Eventually, 43 patients underwent abscess surgery. The factors associated with failed medical treatment were gas-forming abscess (P = 0.006) and septic shock at the initial presentation (P = 0.008). Conclusion. Medical and percutaneous treatment constitute the standard management of liver abscess cases. Surgery remains necessary after failure of the initial treatment but should also be considered as an early intervention for cases presenting with gas-forming abscesses and septic shock and when treatment of the underlying cause is immediately required.

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