The recent results of liver resection for hepatocellular carcinoma are generally satisfactory; however, the recurrence rate is still high.

Background. Protein induced by vitamin K absence or antagonist II (PIVKA‐II) was widely used as a diagnostic marker for hepatocellular carcinoma (HCC), however, its prognostic value is unclear. The authors evaluated PIVKA‐II clinicopathologically as a prognostic marker for HCC. Methods. The relationship between pathologic prognostic factors and plasma PIVKA‐II and alpha‐fetoprotein (AFP) was investigated in 72 patients with resectable HCC measuring less than 6 cm in greatest dimension. Results. PIVKA‐II shows significantly lower sensitivity, but higher specificity than AFP, and the use of these two complementary markers appears to be useful in the diagnosis of HCC. The frequencies of intrahepatic metastasis, portal vein tumor thrombus, hepatic vein tumor thrombus, and capsular infiltration were significantly higher in patients with positive PIVKA‐II than in those with negative‐PIVKA‐II, and the recurrence‐free rate was significantly lower in patients with positive rather than with negative PIVKA‐II. However, there were no significant differences between the patients who were AFP positive and those who were AFP negative in pathologic prognostic factors and the recurrence‐free rate. From univariate and multivariate analyses, the authors find that PIVKA‐II is one of the risk factors for recurrence of HCC after hepatectomy. Conclusions. PIVKA‐II may be a useful marker for the prediction of intrahepatic spread and for the prognosis of HCC. In addition, PIVKA‐II‐positive patients, thus, need aggressive postoperative adjuvant therapy for undetectable residual tumors and careful postoperative monitoring to enable the early recognition of recurrence.

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Despite recent progress in diagnostics for hepatocellular carcinoma, the rate of resectability remains low, mainly because of the advancement of the underlying liver disease. We report a case of a 54-year-old man with a hepatocellular carcinoma and poor liver function that was treated successfully with a laparoscopic hepatic resection. Laparoscopic hepatic resection is considered to be feasible with the aid of an ultrasonic dissector and a microwave coagulator; however, close attention should be paid to the development of air embolism and hepatic vein injury.

To assess the differences in the surgical results between patients with hepatitis B- and hepatitis C-related hepatocellular carcinoma (HCC), the operative outcomes of 30 patients with hepatitis B surface antigen (HBsAg)-positive (the B-HCC group) and 96 patients with hepatitis C antibody (HCVAb)-positive (the C-HCC group), who had undergone hepatic resection from 1989 to 1993, were compared. The mean age of the patients in the C-HCC group was higher than that in the B-HCC group (61.7 years vs. 57.0 years, P < .05). The C-HCC group demonstrated both a greater decrease in liver function and a larger enhancement of inflammatory changes in the liver under a pathological examination (the current rate of active hepatitis: 69% vs. 27%, P < .001). There was also a higher incidence of total postoperative complications in the C-HCC group (60% vs. 37%, P < .05); however, regarding each individual complication, the rate was similar between the two groups. Two of the six patients with postoperative hepatic failure in the C-HCC group died. The mortality rate in the C-HCC group was 2%, but no operative death was encountered in the B-HCC group. The crude survival and the disease-free survival rates at 5 years were similar, 61.8% and 46.2% in the B-HCC group and 52.8% and 23.2% in the C-HCC group, respectively. The patterns of recurrence were also similar in both groups. The pathological features of HCC were similar between the two groups. In conclusion, the surgical results between the two groups were almost identical.(ABSTRACT TRUNCATED AT 250 WORDS)