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KMID : 0870419970010010055
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
1997 Volume.1 No. 1 p.55 ~ p.62
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Indication and Limitation of Hepatectomy in Advanced Hepatocellular Carcinoma
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Kim Hong-Jin
Son Dae-Ho
Song Ki-Hwan
Kwun Koing-Bo
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Abstract
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Background/Aims: There are limitaions in treatment for advanced hepatocellular carcinoma(HCC). In an effort to break through these limitations, we investigated the effectiveness of multimodal therapy which has been regarded as a
contraindication for surgical treatment.
Methods: We studied 102 cases of Hepatic resection for HCC between June 1994 and June 1995. Among them, we analyzed 8 cases with huge main tumor occupying more than one lobe: 8 cases of HCC with tumor thrombi in the
main or first branch of portal vein(PV) and hepatic vein thrombosis requiring additional thrombectomy; 10 cases with tumor thrombi of extrahepatic bile duct(BD) requiring additional extirpation of tumor fragments in the BD; 4 cases of HCC with hepatic rupture; and 4 cases with lymph node metastasis or distandt metastasis.
Results: Overall survival rate was 64.1% at 1 year, 22.1% at 3 years and 4.8% at 5 years. The cumulative survival rates in the combined hepatectomy and embolization group(58.1%, 33.3% and 8.4% at 1, 3 and 5 years after hepatectomy, respectively) were significantly higher than those in the hepatectomy only group(66.7%, 4.3% and 0% at 1, 3 and 5 years, respectively; p<0.05). The cumulative survival rates in the complete resection group(66.7%, 21.2% and 0% at 1, 3 and 5 years after hepatectomy, respectively) were better than those in the incomplete resection group(36%, 16.7% and 11.8% at 1, 3 and 5 years, respectively; p>0.05). All patients with distant metastasis died of early recurrence within 1 year despite surgical treatment. By contrast, patients with large tumor with intrahepatic metastasis, BD tumor thormbi, or hepatic rupture of HCC survived longer(mean survival rate of 2.5 years) because of a combination of hepatic resection, and additional postoperative treatment; hence, some patients were able to enjoy a longer life.
Conclusion: Multimodal treatment including hepatic resection should be encouraged for advanced HCC patients with hepatic rupture, BD tumor thrombi, or intrahepatic metastasis, as long as the liver can overcome postoperative liver ailure.
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KEYWORD
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Hepatocellular carcinoma, Multimodal treatment, Hepatic resecton, Surgical indication
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