Pedunculated primary hepatocellular carcinoma

This report describes six cases of liposarcoma. The primary sites were the retroperitoneum in three cases, the lower extremity in two cases and the jejunal mesenterium in one case. One retroperitoneum case had the heaviest liposarcoma (40 kg) that has been reported in the literature. One patient with thigh liposarcoma who developed three recurrences and underwent hemipelvectomy has been free from the disease for the past 6 1/2 years. Histologically, all three retroperitoneum cases showed well-differentiated liposarcoma and two lower extremity cases had myxoid type liposarcoma.     

Pedunculated hepatocellular carcinoma. Report of three cases and review of literature

Pedunculated hepatocellular carcinoma (HC) is rarely found in the United States and Europe. There have been several cases in Japan. The diagnosis of pedunculated HC is said to be very difficult. This article describes three cases of pedunculated HC which were diagnosed preoperatively and were resected successfully. Celiac angiography and CT scan were useful diagnostic procedures. World literature is reviewed, and 15 documented cases of pedunculated HC have been found, including the three cases presented. It may be assumed that pedunculated HC may arise from the accessory lobe of the liver or ectopic liver tissue.     

Progress in surgical treatment of hepatocellular carcinoma

Surgery for hepatocellular carcinoma has improved dramatically during the last two decades, and the improvement is mainly attributable to the development of intraoperative ultrasound-guided operative procedures such as Makuuchi's segmentectomy, introduction of the intermittent vascular occlusion technique, and establishment of the precise criteria for indications of various hepatectomy procedures. The use of preoperative portal vein embolization for inducing compensatory hypertrophy of remnant liver in the future has increased the safety and extended indications of hepatectomy for hepatocellular carcinoma. Operative mortality has fallen below 2% in the 1990s, with the 5-year survival rate reaching nearly 50% in a recent nationwide survey in Japan. More than 90% of hepatectomies at our institution are performed without red blood cell transfusions, and the mean hospital stay is shortened to approximately 23 days. Moreover, not a single case of operative death has been recorded since 1993.     

Controversy as to the surgical treatment of hepatocellular carcinoma

Surgery has been the standard treatment modality for patients with hepatocellular carcinoma, however, controversy exists as to 1. which treatment is better for small HCC (surgery versus local ablation), 2. surgical indication for advanced HCC with multiple tumors, tumor thrombus, or extrahepatic metastasis, and 3. indication of liver transplantation. These points were discussed reviewing our results and current papers.     

Effect of surgical and chemotherapeutic treatment on alpha-fetoprotein levels in patients with hepatocellular carcinoma.

Quantitative determinations of serum alpha-fetoprotein (AFP) by radioimmunoassay in 193 patients with hepatocellular carcinoma have demonstrated a wide variation in serum levels that appear to be relatively constant for each patient by the time that diagnosis is made. If there is no therapeutic intervention the serum AFP usually follows a gradual increase as the tumor progresses. A few patients have a fall in serum AFP as a preterminal event. Various forms of chemotherapy cause only minor and transient decrease in serum AFP. Surgical resection of tumor produces an immediate fall that parallels the catabolic decay rate for AFP. All AFP-positive patients treated with surgery had recurrence of their tumor with a rise in serum AFP preceeding clinical discovery. The correlation of serum AFP and effective treatment is demonstration of the usefulness of this oncofetal protein marker as an indicator of neoplastic activity for hepatocellular carcinoma and tumors with embryonal cell components and possibly for some other entodermally derived neoplasms.     

Nonsurgical treatment of hepatocellular carcinoma.

While surgical resection and tumor ablation are the preferred therapies for hepatocellular carcinoma (HCC), these are available or appropriate in only a minority of patients. This reflects the usual comorbidity of severe underlying liver disease that either precludes surgery or makes the surgical approach extremely dangerous. Nonetheless, regional control of HCC is highly relevant and many regional strategies have been explored, including hepatic intra-arterial chemotherapy transarterial chemoembolization, lipiodol chemoembolization, radiation therapy, cryosurgery, percutaneous ethanol injection, and radiofrequency ablation. In addition, a variety of systemic chemotherapeutic agents have been tested in HCC, including various combinations of 5-fluorouracil, doxorubicin, epirubicin, etoposide, cisplatin, and mitoxantrone, as well as interferon, tamoxifen, capecitabine, thalidomide, and octreotide. Published data regarding these regional and systemic therapies will be discussed in this review.     

影响肝细胞癌术后长期生存的相关因素

通过对复旦大学肝癌研究所20世纪90年代手术治疗的2333例肝细胞癌病例的分析,旨在寻找与长期生存的相关因素.其中根治性切除1465(62.8%)例,姑息性切除868例(37.2%).随访至2003年底,术后存活5年以上者527例,其中根治性切除组454例,姑息性切除组73例.根治性切除后长期生存的相关因素为肿瘤的发现途径,肿瘤大小、包膜,肿瘤细胞的分化程度,肝硬化程度,血清γ-GT水平.姑息性切除后长期生存的相关因素为肿瘤大小、肿瘤包膜、γ-GT、肝硬化程度、术后TACE和二步切除是长期生存独立的影响因素.术后复发的病人经过综合治疗后也能达到比较理想的长期生存率.     

原发性肝癌合并肝硬化及脾功能亢进围手术期处理及手术方式的选择

目的探讨原发性肝癌合并肝硬化及脾功能亢进的围手术期处理和术式选择。方法选取2005年3月至2015年3月间收治的60例原发性肝癌合并肝硬化及脾功能亢进的患者,其中采用肝癌切除+脾切除20例,肝癌切除+脾切除+贲门周围血管离断术15例,肝癌切除+脾动脉结扎13例,单纯肝癌切除12例,观察4种手术方式的治疗效果。结果单纯肝癌切除患者和肝癌切除+脾动脉结扎患者术后白细胞(WBC)、血小板(PLT)水平明显低于肝癌切除+脾切除+贲门周围血管离断术和肝癌切除+脾切除患者,差异有统计学意义(P<0.05);术后单纯肝癌切除患者谷氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(Tbil)和CD8~+T细胞比较明显高于其他3组,CD4~+和CD4~+/CD8~+T细胞比例明显低于其他3组,差异有统计学意义(P<0.05)。结论肝癌切除联合对脾脏进行处理对原发性肝癌合并肝硬化及脾功能亢进患者治疗效果明显,能够提高患者术后生存时间和生存质量。     

小肝癌切缘复发预防及临床处理方法的探讨

背景与目的随着医疗诊断技术的提高,越来越多的小肝癌被发现,目前治疗小肝癌首选的方法仍是手术切除,但其术后复发率高达60%以上。本研究中我们对临床小肝癌进行回顾对照分析,拟探讨降低小肝癌手术切缘复发率的方法。方法回顾性分析广东省开平市中心医院和中山大学肿瘤医院在1991年1月～2003年5月间收治的283例小肝癌患者的临床病理资料。由于85%以上的肝癌患者合并不同程度肝硬化和肝储备功能不良,故以非规则性肝切除术为主。其中作肿瘤剔出术加残端切缘注射无水乙醇或无水乙醇明胶海绵创面填塞术140例(研究组);143例仅作普通常规处理(对照组)。比较两组患者的年龄、性别、肿瘤部位、肿瘤分期、Child-Pugh分期无统计学意义。结果研究组和对照组切缘1年复发率分别为21.4%和4.4%,有显著性差异(P<0.05);肝内转移/再发率分别为26.1%和24.5%,无统计学意义(P>0.05)。研究组和对照组5年总生存率分别为57.3%、52.8%(P=0.48),5年无瘤生存率分别为35.2%、36.9%(P=0.51)。两组患者术后一周内体温均在39℃以下;均无明显白细胞升高、胆漏及出血出现。结论不规则肝切除术后残端用无水乙醇明胶海绵填塞,或在残端处注射无水乙醇,对减少术后残端局部复发有一定效果,但对术后转移复发再发无作用,此法简单经济实用,便于推广应用,副作用少。     

50例小肝癌外科治疗的临床分析

５０例小肝癌诊治表明，手术切除后复发率５７．１％（２８／４９），１年复发６０．７％（１７／２８），２年复发８５．７％（２４／２８），２８例复发病人中，肝门型１６例，非肝门型１２例，不同类型的复发时间有显著性差异（ｘ＾２＝５．２５，Ｐ〈０．０２５）。肝内复发２４例中按Ｍａｔａｓｕｍａｔａ分型：Ⅰ型３例，Ⅱ型１２例，Ⅲ型９例，Ⅱ、Ⅲ型占８７．５％（２１／２４）。切除术后３年及５年生存率分别为６７％及５     

Successful surgical management of pulmonary and adrenal metastases from hepatocellular carcinoma.

This article reports a rare case of successful surgery for both lung and adrenal metastases after hepatic resection of hepatocellular carcinoma (HCC). A 55-year-old Japanese man with a 5-year history of chronic liver disease was admitted with an elevated serum alpha-fetoprotein (AFP) value and a liver tumour detected by ultrasonography. Hepatic angiogram showed a tumour stain with the right hepatic vein as a venous drain from the tumour. He underwent posterior-inferior subsegmentectomy of the right hepatic lobe following preoperative chemoembolization. Sixteen months after the first operation, he received pulmonary resection for a solitary metastasis in the right lung. A further 10 months later, a metastatic tumour was detected in the left adrenal gland without any recurrent or metastatic foci, and he underwent left adrenalectomy as his third operation. He is still alive, 8 months after his last operation, and 34 months after hepatic resection, with a normal value of AFP and without any recurrent or metastatic foci. This may be the first report of a patient who underwent successful surgery for pulmonary and adrenal metastases of HCC.     

Advances in surgical therapy for hepatocellular carcinoma

The first therapeutic option for hepatocellular carcinoma (HCC) is systematic liver resection. Recent advances in operation techniques and peri-operative management have contributed to enlarging the indications of liver resection for HCC, and served to improve the long-term survival. Only liver resection can be a curative treatment for HCC with portal venous tumor thrombus.     

外科手术治疗肝癌合并门静脉癌栓的疗效分析

目的 探讨肝细胞癌（HCC）合并门静脉癌栓（PVTT）患者行外科手术治疗的疗效。方法 收集1998年1月至2008年12月34例经手术治疗的HCC合并PVTT患者的临床诊治资料并进行回顾性分析。结果 34例HCC合并PVTT患者术后1个月内死亡2例,32例恢复良好。获随访29例（90.6％）,中位生存时间为16.2个月,1、2、3、4、5年生存率分别为51.7％、37.9％、24.1％、10.3％和3.4％。其中术后行门静脉及肝动脉双置管灌注化疗者23例,1、2、3、4、5年的生存率分别为57.1％、42.9％、28.6％、14.3％和4.7％,中位生存时间为19.6个月;单纯手术组9例,1、2、3、4、5年的生存率分别为45.0％、22.2％、11.1％、0、0,中位生存时间为13.5个月。两组生存率比较,差异有统计学意义（P＜0.05）。结论 肝切除加PVTT摘除术是治疗HCC合并PVTT有效的方法之一,术后门静脉和肝动脉双置管灌注化疗能提高患者远期生存率。     

Surgical treatment for hepatocellular carcinoma

Surgery is the most important therapeutic approach for patients with hepatocellular carcinoma. We have reviewed patients' survival after resection for hepatocellular carcinoma in 17 series since 2000, each including more than 100 patients. Median survival rates were 80% (range 63-97%) at 1 year, 70% (34-78%) at 3 years and 50% (17-69%) at 5 years. Such wide ranges of survival rates are attributed mainly to differences in the hepatocellular carcinoma stage among studies, but the survival rate is obviously much better for early hepatocellular carcinomas. Today, liver resection is an established treatment for hepatocellular carcinoma owing to minimal surgical mortality and improved survival. Liver transplantation is one of the best treatments for hepatocellular carcinoma in patients who meet the selection criteria. Further studies are needed to establish suitable criteria for transplantation in patients with hepatocellular carcinoma. For patients who are not candidates for liver resection or transplantation, percutaneous ablation is the best treatment option. However, no randomized controlled clinical trial has compared the results of ablation with those of surgical therapy for hepatocellular carcinoma, and none of the ablation techniques have been shown to offer a definitive survival advantage. A treatment algorithm based on published evidence is now available, which helps us to select the most suitable therapeutic option for individual patients, depending on tumor characteristics and liver functional reserve. This review paper summarizes the current status of the surgical management of hepatocellular carcinoma.     

Surgical treatment of hepatocellular carcinoma

The result of surgical treatment for hepatocellular carcinoma in National Cancer Center Hospital is reported. Almost 80% of the cases in this series are cirrhotic. The cases were divided into two groups according to the period when hepatectomy was done, as the first half, [A], was from 1974 till 1981 when the treatment was only surgical removal and the latter half, [B], was from 1982 till the end of March, 1986 when pre- and post-operative embolization was combined with hepatectomy. The operative mortality rate was 10.1% (9/89) for [A] and 2.2% (3/121) for [B]. The cumulative survival rates of [A] for the 1st-5th year were 65.8%, 52.6%, 39.5%, 32.9% and 27.2%, respectively, and those of [B] were 86.1%, 78.1%, 65.1%, 50.6% and 50.6%.     

肝细胞癌治疗进展

外科治疗是肝细胞癌的最佳治疗手段。肝移植的出现进一步提高了肝细胞癌的治愈率。经皮治疗是小肝细胞癌的另一种治疗手段。经动脉化学栓塞是目前惟一明确对生存有益的姑息性治疗手段。化学疗法有效率绝大多数在20％以下,新的化疗方案正在进一步探索中。抗雄激素治疗已确定无效。甲地孕酮、干扰素、分子靶向药物等药物的疗效有待进一步评定。     

Surgical treatment of hepatocellular carcinoma

The surgical treatment for hepatocellular carcinoma must be chosen by considering some factors such as liver function, position and involved area of the tumor. This article reports our guide line for surgical treatment based on liver function and long term survival. In severe cirrhotic patient with ICG retention rate ranging 30 to 40%, hepatectomy can be indicated only when they mach several conditions as follows; KICG from 0.06 to 0.08, superficially located tumor removal by resection of small area with curability. In patients with ICG retention rate lower then 30%, resection range is determined by the multiple regression equation indicating safety limit of hepatectomy. The predictability of the equation has been as high as 93%, the long term survival depends on following factor, i.e.; tumor size, VP factor, and IM factor. Hepatectomy should be first option when the tumor is less than 5 cm in size, VPO, IMO, and can be safely removable with segmentectomy or larger resection.     

Surgical treatment of hepatocellular carcinoma

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.Work presented at the Third International Symposium on Treatment of Liver Cancer, Seoul, Korea, 12–13 February 1993