Surgery for small liver cancers

Abstract

During the last 16 years, we have resected small hepatocellular carcinomas (HCCs) measuring 5 cm or less from 362 patients, 266 of whom also had liver cirrhosis. The operative and hospital mortality rate were 1.7% and 1.9%, respectively. These showed a gradual decrease year by year in parallel with reduction of intraoperative blood loss achieved by the selective vascular occlusion technique and Pringle method. In 1989, 87% of hepatectomy patients were discharged without the need for whole blood transfusion, and 5-year survival was 43.7%. Tumor size, number of tumors, intrahepatic metastasis, vascular invasion, and capsular invasion were significant prognostic factors. Edmondson grade and the operative procedure employed were significantly related to outcome. Our standard policy for selection of operative procedures and perioperative care is described, and the selection of treatment modalities is discussed.

Evolution and revolution of laparoscopic liver resection in Japan

“…From an oncological perspective, optimal segmental territory should be identified before liver transection in anatomical liver resection 49. This concept is also applicable in LLR, in which hepatic inflow vessels are isolated with tape traction and occluded using clips or ties.…”

Current management of hepatocellular carcinoma: An Eastern perspective

“…To assess hepatic function, a Japanese group measured the indocyanine green retention rate at 15 min (ICG15) [26] . Feasibility and the extent of the resection are decided according to the degree of retention of the dye [27] .…”

“…Feasibility and the extent of the resection are decided according to the degree of retention of the dye [27] . Although the BCLC algorithm mandates Child-Pugh A liver function without portal hypertension for hepatic resection, selective resection has been attempted in HCC patients exhibiting upper Child-Pugh B liver function or mild portal hypertension in Asian countries, with reference to the ICG15 value [6,26] . Prognosis after hepatic resection is determined by number and size of tumor, vascular invasion, and level of alpha-fetoprotein [28][29][30] .…”

Can preoperative diffusion-weighted MRI predict postoperative hepatic insufficiency after curative resection of HBV-related hepatocellular carcinoma? A pilot study

“…Choi). Indications for liver resection and the types of operative procedures were mainly determined based on the Makuuchi criteria, i.e., the presence or absence of ascites, the serum total bilirubin level, and ICG R15 [27]. During surgery, intraoperative ultrasonography was routinely performed for all patients to determine tumor localization and extent and to exclude the presence of additional lesions in the residual liver.…”