Between 1989 and 1995, 100 patient underwent hepatic resection for hepatocellular carcinoma (Liver cirrhosis, 65%; chronic hepatitis, 15%; fibrosis, 2%). Clinical and pathologic factors affectingsurvival and recurrence rate were analysed.
100 patients included 78 men(78%) and 22 women(22%), ranging in age from 28 to 76 years (m3an; 51.6years). The 3 years survival after liver resection for all patients, except one operation death(1%) was 39.8%).
By univariate analysis, solitary tumor(p=0.0000), single nodular type(p=0.0000), ex pansile type of growth(p=0.0000), abscence of portal vein invasion and intrahepatic metastasis(p=0.0001, p=0.0010) and negative surgical margin(p=0.0014) showed a
improved survival rate.
Recurrence of the tumor was diagnosed in 39 patients during follow-up with AFP level and imaging studies that were performed every 1-3 months. Initial recurrent tumor were found in the residual liver in 74.4%, the extrahepatic organ in 15.4%, and
simultaneously in both the liver and the extrahepatic organ in 10.2%. Recurrence was diagnosed within 1 year, between 1 and 2 years, and more than 2 years after the hepatectomy in 31(79.5%), 6(15.4%) and 2(5.1%). In 33 patients with intrahepatic
recurrences, 3(9.1%) had a marginal recurrence, 9 had a nodular recurrence, and 21 had a diffuse or multiple recurrence. Multiple tumor, large sized-tumor(> 5cm) and presence of portal vein invasion and intrahepatic metastasis, positive surgical
margin
had a significantly higher recurrence rate.
Number of the tumor, presence or abscence of portal vein invasion and intrahepatic metastasis, negative surgical margin were very important factors of survival and recurrence rate. Of the 15 patients who treated with preoperative portal vein
embolization during the percutaneous transhepatic portography, recurrence of the tumor was diagnosed in 2(13.3%) patients. This procedure prevented intrahepatic metastasis and caused hypertrophy of the liver. Combination of PVE and surgical
resection
may provide the best results, but randomized controlled trials with long-term follow-up are needed.
To obtain successful long-term survival after surgery for heaptocellular carcinoma, we might consider the preoperative adjuvant therapy and even after curative resection, postoperative adjuvant therapy to prevent recurrence or prolong the time
until
recurrence, and it is necessary to repeat active adjuvant therapies against the recurrent liver.
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