Surgical treatment of hepatocellular carcinoma

Abstract

The effect of surgical treatment for hepatocellular carcinoma (HCC) was evaluated in 149 resected cases, 83.2% of which were associated with liver cirrhosis. The 3- and 5-year survival rates were 60.1% and 39.4%, respectively. The mortality rate was 4.1%. In patients aged over 70 years, liver cirrhosis was found in 53.3% of cases and the mortality rate was 6.7%. The 3- and 5-year survival rates were 50.8% and 33.9%, respectively. Factors that significantly affected survival for more than 5 years were a tumor size of less than 3 cm, Stage I disease, vp(-), IMo, and diploid type. The 5-year survival rate for patients with a single tumor of 3 cm or less was 54.2%, regardless of the surgical procedure. All 15 patients with a solitary tumor of 2 cm or less (Stage I, small liver tumor) were alive with a 5-year survival rate of 100%. The problem is the treatment of patients with a tumor measuring 3-5 cm in diameter and associated liver cirrhosis, because their prognosis after surgery is the worst. HrS (subsegmentectomy) is the minimal procedure of limited hepatectomy for these cases with postoperative multidisciplinary therapy.

Long term results of single session percutaneous ethanol injection in patients with large hepatocellular carcinoma

“…24 More recent series [25][26][27][28][29] report survival rates from 23-63%, which thus are as low or lower than those attained in Group A patients with single session PEI (i.e., 57%). This is not easy to explain, because resection should have ensured radicality whereas PEI in this study achieved complete necrosis in 58% of cases.…”

“…This is not easy to explain, because resection should have ensured radicality whereas PEI in this study achieved complete necrosis in 58% of cases. The explanation most likely is to be found in the fact that the lower success rate obtained with PEI is counterbalanced by the low perioperative mortality, (i.e., 0.8% vs. 4 -11% for surgery [25][26][27][28][29] ) and by the reduced damage to healthy tissue, which in some resections may prove excessive and lead to liver failure. Another factor could be that the amount of necrosis, which also is high in partial responses, was able to greatly retard the neoplastic growth and therefore improve survival.…”

Long term prognosis after hepatectomy for hepatocellular carcinoma

“…[12][13][14] Nonami et al 14 and Franco et al 15 demonstrated a good correlation of Child's classification with postoperative survival. At our institution, Child's classification is used as the preliminary step in selecting patients for hepatectomy, and Child's C status is considered unsuitable for hepatic resection.…”

Hepatocellular Carcinoma Cases with Five-Year Survival and Prognostic Factors Affecting the Survival Time.

“…Several investigators (Kawano et al 1989;Yamanaka et al 1990;Hsih et al 1992;Nakao et al 1992;Yamamoto et al 1992;Kawarada et al 1994) have studied these factors in relation to TAE or surgical results. Significant factors previously reported (Kawano et al 1989;Yamanaka et al 1990;Hsih et al 1992;Nakao et al 1992;Yamamoto et al 1992;Kawarada et al 1994) could be divided into three groups; cirrhotic, tumor and therapeutic factors. Cirrhotic factors included serum total bilirubin level, Child's classification, HBsAg negativity and the maximal removal rate of indocyanine green (Rmax).…”