Role of surgery in the treatment of primary carcinoma of the liver: A 31-year experience

Abstract

During the 31 year period 1954 to 1985, 225 major hepatic resections have been performed for symptomatic primary carcinoma of the liver, of which right hepatic lobectomy was performed in 115, extended right hepatic lobectomy in 11, trisegmentectomy in 2, left hepatic lobectomy in 94, and middle hepatectomy in 3. In addition there were 107 partial hepatic resections for 89 asymptomatic small hepatocellular carcinomas. In the 225 patients undergoing major hepatic resection, the operative mortality was 8.0 per cent. In the 107 patients undergoing partial hepatic resection, the operative mortality was 5.6 per cent. Of the total of 314 hepatic resections for primary carcinoma of the liver, 309 were undertaken for hepatocellular carcinoma and the remaining 5 were carried out for cholangiocarcinoma. All hepatic resections in this series were performed with the finger fracture technique without controlling the hepatic hilar vessels, hepatic ducts or hepatic veins outside the liver, although hepatic clamping and the Pringle manoeuvre were also used in selective cases. Of 207 cases who survived major hepatic resection, 119 cases died within one year after the operation, mainly due to recurrence of cancer in the remaining residual lobe, lung metastasis or late hepatic failure. The 5 year survival rate is 18.0 per cent, 12 patients are still alive and well after more than 5 years and the longest survival is 23 years. Of the 89 patients with small asymptomatic hepatocellular carcinomas, 28 died within one to four years of surgery because of a second new growth.

Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid

“…[1][2][3][4][5] Despite many technical advances, intraoperative bleeding remains a problem during liver resection with 30-40% of patients receiving perioperative blood transfusions. [6][7][8] Blood transfusion carries several risks, including transfusion-transmitted viruses, transfusion-related acute lung injury, transfusion-associated circulatory overload, acute hemolytic transfusion reactions, bacterial contamination and severe allergic reactions.…”

Novel endothelial cell markers in hepatocellular carcinoma

“…Surgical resection or liver transplantation for early stage tumors is considered the only curative treatment in HCC. 6 However, because HCC tumors are generally asymptomatic during the early stages, more than 80% of patients have unresectable tumors at the time of diagnosis. 7 Systemic chemotherapy and/or radiotherapy are not effective treatment for HCC.…”

Experience with Resection of Primary Hepatic Malignancy

“…7,8,10,11 Acknowledging the limitation in comparing the survival rates without proper staging of the malignant tumor, our 1-, 3-, and 5-year actuarial survival rates of 68.5 per cent, 45.1 per cent, and 31.9 per cent, respectively, are similar to or even better than those reported in the literature. 1,4,9 The fact that more than half of our patients required trisegmentectomy to remove their massive tumors illustrates the advanced stages of malignancy in our series. Despite this, 18 patients lived more than 5 years after hepatic resection, and 14 did so after trisegmentectomy.…”

“…1,[4][5][6]9 In our most recent review of 411 hepatic resections, 5 the overall operative mortality rate was 3.2 per cent. The mortality rate was the highest, 6.3 per cent (9 of 142), after trisegmentectomy and only 1.9 per cent (3 of 158) after lobectomy.…”