The seventies evolution in liver surgery for cancer

Abstract

During the past decade, one of the major changes in the field of oncology has been in the surgical approach to primary and secondary cancer of the liver. As a result of data and experience gained in liver transplantation programs and with the application of vascular surgical principles, resectability rates have been increased. The present rate of 32% has been achieved with an overall 30-day operative mortality rate of 9%. More sophisticated intraoperative and postoperative supports have been essential in achieving these results. The median operating time is now 4 3/4 hours in length. Complications are minimal. The median postoperative hospital stay is now 13 days. During the past decade, 436 patients with liver tumors were treated by the authors. It has become apparent in this experience and in that reported by others that an increasing number of patients with primary liver cancer or metastatic cancer in the liver can be cured by surgery with minimal operative risk. Adjuvant chemotherapy may increase the salvage rate. Current therapeutic results are best evaluated after staging of the liver disease: Stage I (no involvement of margins of resection, hepatic vascular structures or bile ducts; all gross disease removed): 85% three-year survival estimate, using the Kaplan-Meier method, for individuals with primary liver cancer; 71% for those with metastatic colorectal cancer. Stages II and III (regional or extrahepatic spread): 22% three-year survival for individuals with primary liver cancer but no survivors at two years with metastatic colorectal cancer. These data permit better selection of patients who are most likely to benefit from surgery.

Pathologic and Radiographic Studies of Intrahepatic Metastasis Hepatocellular Carcinoma; The Role of Efferent Vessels

“…In 8 An abundant vascular network was noted in tumor capsules, and communicating branches between blood spaces in the tumor and this vascular network were observed in all cases. Serial sections showed that tumor cells were disseminated through these communicating branches and were also present within the vascular network of the capsule in most of the resected specimens.…”

Experience with 150 Liver Resections

“…Foster reviewed more than 400 hospital records of patients with metastatic liver tumor from colorectal cancer and reported in 1978 two-and five-year determinant survival, respectively, of 44% and 22%, excluding the patients who died during the initial hospitalization. 8 Fortner et al reported one-, two-, and three-year actuarial survival of 88%, 48%, and 48% excluding an operative mortality of 8%.20, 21 Wilson and Adson reported a five-year survival of 28% among 60 patients with liver metastasis from colorectal cancer, two thirds of whom were treated by wedge resection of the liver.23 Later, Adson and Van Heerden reported one-, two-, and threeyear actual survival, respectively, of 82%, 58%, and 44% among 34 patients who had major hepatic resections excluding operative deaths. 24 The authors have obtained one-, three-, and five-year actuarial survival, respectively, of 91.3%, 73%, and 52.1 % in patients with metastatic colorectal cancer without any operative mortality.…”

Experience with Resection of Primary Hepatic Malignancy

“…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.…”

“…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.…”