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KMID : 0870419970010010063
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
1997 Volume.1 No. 1 p.63 ~ p.72
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Surgical Treatment of Stage IV hepatocellular Carcinoma
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Nah Yang-Won
Lee Hyuck-Sang
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Abstract
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his study was conducted to clarify the strategy of surgical treatment for stage Ⅳ hepatocellular carcinoma(HCC), for which no effective treatment modality is present so far. There were 29 patients(19.7%) with stage Ⅳ HCC among 147 HCC patients who underwent partial liver resection during the period from Jan. 1985 through Dec. 1996 at our department. The mean age was 53 years with a range of 18 to 76 years. There were 23 men and 6 women with a ratio of 4:1. Positive rates for HBsAg and HCV Ab were 55.2% and 12.5%, respectively. Ninety percent of the patients were complicated by chronic liver disease. Abdominal pain and/or mass were the predominating symptoms in about 60% of the patients. Serum AFP level was elevated above 20ng/㎖ in 72.4% of the cases. Twenty-three patients harbored stage Ⅳ-A disease and 6 patients Ⅳ-B disease. The main surgical procedures used in the cases were trisegmentectomy in 3, lobectomy in 12, segmentectomy in 12, subsegmentectomy in 1 and wedge resection in 1. Additionally wedge resection of the liver was performed in 6 cases and ethanol injection in 9 cases. Among 11 cases with tumor thrombus in large portal veins, successful tumor thrombectomy was conducted in 7 of them. Out of 23 patients with stage Ⅳ-A HCC, complete tumor removal was possible in 8 and ethanol injection into the residual tumor was executed in another 6. The mean operation time was 282 minutes and the mean transfusion 4 pints. Four patients(13.8%) suffered from postoperative complications, 2 of whom succumbed to liver failure 2 months postoperatively. The cumulative survival rates at 1, 2 and 3 years after surgery were 35.1%, 17.6% adn 11.7%, respectively, with a median survival time of 11 months. The longest survivor is alive 63 months after surgery. Significant prognostic factors were gross portal vein thrmobosis, invasion into adjacent tissues, tumor rupture, and the development of complications. In particular, the survivial of patients with stage Ⅳ-A HCC who underwent complete tumor removal was not statistically different from that of those who had an absolute noncurative operation plus intraoperative ethanol injection into the residual tumors. For stage Ⅳ-A HCC surgical treatment is considered to effective when all the tumors can be removed or when the residual tumors can be treated by intraoperative ethanol injection.
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KEYWORD
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Hepatocellular carcinoma, Liver resection, Ethanol Injection
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