Effectiveness of systematized hepatectomy with Glisson's pedicle transection at the hepatic hilus for small nodular hepatocellular carcinoma: retrospective analysis

BACKGROUND: The effectiveness of systematized hepatectomy with transection of Glisson's pedicle at the hepatic hilus in patients with small nodular hepatocellular carcinoma (HCC) has not been confirmed. METHODS: Surgical outcomes were reviewed in 204 patients with single nodular HCCs less than 5 cm in greatest diameter, including 68 patients with tumors that showed extranodular growth and 136 patients with tumors that did not, who had undergone curative hepatectomy (partial hepatic resection, n = 114; systematized hepatectomy, n = 90) from 1990 through 1994. RESULTS: The rates of microscopic vascular invasion and intrahepatic metastasis were significantly higher in patients who had single nodular HCCs with extranodular growth (34% and 49%) than in patients who had single nodular HCCs without extranodular growth (13%, P =.001, and 4%, P <.001). The 5-year survival rate in patients who had single nodular HCCs with extranodular growth was significantly greater after systematized hepatectomy (67%) than after partial hepatic resection (21%, P =.0002). Multivariate analysis showed that the type of operation was an independent prognostic factor in patients with single nodular HCCs with extranodular growth (P =.0008). CONCLUSIONS: Systematized hepatectomy with Glisson's pedicle transection at the hepatic hilus should be performed in patients who have single small nodular HCCs with extranodular growth because these tumors often invade within the liver sector containing the tumor.     

Clinicopathologic features and postoperative prognosis of multicentric small hepatocellular carcinoma

BACKGROUND: Assessment of clinicopathologic characteristics and postoperative prognoses for patients with multicentric hepatocellular carcinoma (HCC) is important to determine not only a need to operate, but also an appropriate treatment after hepatic resection. STUDY DESIGN: Between May 1990 and April 1998, among 116 patients with an initial hepatectomy for HCC measuring 3 cm or less in maximum diameter, 34 patients had multicentric HCC (MC group), and 82 patients had single nodular HCC (SN group). To clarify the clinicopathologic features of patients in the MC group versus the SN group, we compared both the clinicopathologic parameters and the postoperative prognosis after curative hepatectomy between the two groups. RESULTS: The percentages of patients positive for hepatitis B surface antigen and hepatitis C virus antibody were not significantly different between the two groups. No differences were noted in pathologic characteristics of the main tumor or tumor markers. On the other hand, in the MC group, the percentage of patients evaluated in a Child's classification as either B or C was significantly higher (p < 0.05) than that of patients in the SN group, indicating that patients with multicentric HCC have a poor hepatic functional reserve. Both survival and disease-free survival of patients in the MC group who underwent a curative hepatectomy did not differ statistically from those in the SN group. CONCLUSIONS: Our results indicate that hepatic resection is useful, even for patients with multicentric HCC, if a curative hepatectomy can be performed and liver function can be saved, despite their poor hepatic functional reserve.     

Evaluation of hepatectomy in small hepatocellular carcinoma--comparison with transcatheter arterial embolization therapy]

Therapeutic effect on 81 hepatectomized patients with hepatocellular carcinoma (HCC) less than 5cm in diameter was compared to that achieved by transcatheter arterial embolization therapy (TAE) in 61. The 5-year cumulative survival rate after hepatectomy was 38%, which was better than that of TAE (8%). Outcome after hepatectomy was better than that after TAE, according to tumor size in less than 2cm in diameter and single nodule. The 3-, and 5-year survival rates for curative hepatectomy were significantly better than those for TAE. But there was no significant difference in survival curves between relative noncurative hepatectomy and TAE. In terms of hepatic reserve with reference to Child's classification, the survival curve for TAE was better than that for relative noncurative hepatectomy in patients with Child-A, but there was no significantly difference between these two methods. Survivors more than 3 years after hepatectomy and TAE were 24 (48.0%) and 11 (23.4%) patients, respectively. Nineteen of 24 patients with hepatectomy had recurrent HCCs, of which reresection was done in 6, TAE in 11 and other treatments in 2. The advantage of hepatectomy in comparison with TAE is a possibility of long-term survival, if curative hepatectomy is performed.     

Efficacy of anatomic resection vs nonanatomic resection for small nodular hepatocellular carcinoma based on gross classification

Background/Purpose  It has been reported that anatomic resection may be preferable to nonanatomic resection for small hepatocellular carcinomas (HCCs), by reducing socalled “micrometastases” (portal venous tumor extension and intrahepatic metastases). Nonanatomic resection or ablation has also been used as therapy for small HCCs. We studied the effectiveness of anatomic resection for small nodular HCCs, especially from the viewpoints of tumor size and gross classification. Methods  A retrospective cohort study was performed in 116 consecutive patients who underwent curative hepatic resection for HCCs 3 cm or smaller and with three or fewer nodules. The outcome of anatomic resection (including segmentectomy, sectoriectomy, and hemihepatectomy) was compared to that of nonanatomic partial hepatectomy. Results  The group that underwent anatomic resection (n = 52) had relatively better overall survival and significantly better recurrence-free survival than those with nonanatomic resection (n = 64). On Cox multivariate analysis, however, liver function was more closely associated with survival. The effect of anatomic resection was more prominent in the subgroup with the nonboundary type nodules (single nodular type with extranodular growth, confluent multinodular type, and invasive type) than in the subgroup with the boundary type (vaguely nodular and single nodular type). Micrometastases in the nonboundary type were found further from the main tumor (9.5 ± 6.2 mm) than those in the boundary type (within 3.1 +-1.4 mm). Conclusions  In patients with HCC nodules equal to or less than 3 cm and with the nonboundary type, anatomic resection should be employed to the extent that liver function allows, because this procedure would be more favorable than nonanatomic resection in eradicating micrometastases that have extended away from the tumor’s margin.     

A new macroscopic classification predicts prognosis for patient with liver metastases from colorectal cancer.

OBJECTIVE: The authors defined a new macroscopic classification of liver metastases from colorectal cancer. SUMMARY BACKGROUND DATA: There were different prognostic results after the same operative procedure for liver metastases with similar background factors. METHODS: Eighty-one resected liver metastases were classified into simple nodular (SN) or confluent nodular (CN) types according to the characteristics of the cut surface of the tumor. RESULTS: The 5-year survival rates after hepatectomy were 41.7% for the SN lesions (n = 39) and 23.1% for the CN lesions (n = 42). The difference between the survival curves was statistically significant (p = 0.0307). Multivariate analysis using Cox's proportional hazards model revealed that the macroscopic type (p = 0.023), the tumor diameter (p = 0.0001), and the presence of lymph node metastases (p = 0.0016) were statistically significant independent prognostic factors. CONCLUSION: The new macroscopic classification may be valuable as a prognostic factor reflecting the biologic behavior of liver metastases.     

Prognostic benefit of selective portal vein occlusion during hepatic resection for hepatocellular carcinoma

BACKGROUND: The aim of this study was to clarify whether the types of portal vein (PV) occlusion during hepatectomy affect the long-term outcome in patients with hepatocellular carcinoma (HCC). METHODS: Eighty-six patients who had undergone curative hepatic resection for HCC were divided on the basis of the type of PV occlusion into 2 groups: total PV occlusion (TPVO, n = 56) and selective PV occlusion (SPVO, n = 30) groups. The recurrence-free survival was compared between the groups, and factors affecting recurrence-free survival were examined by univariate analyses followed by multivariate analyses. Moreover, the patients with a single nodular HCC less than 5 cm in diameter were abstracted from both groups, and the recurrence-free survival rate was compared. RESULTS: The patients and tumor-related factors were similar in the TPVO and SPVO groups. The recurrence-free survival was better in the SPVO group than in the TPVO group (median recurrence-free survival time, 1520 vs 561 days, P = .017). The type of PV occlusion was a significant factor for recurrence-free survival by univariate analysis but did not reach significance ( P = .052) by multivariate analysis. In the selected patients who had a single nodular HCC less than 5 cm in diameter, the recurrence-free survival was also significantly better in the SPVO group than in the TPVO group (median recurrence-free survival time, 2613 vs 1003 days, P = .018). CONCLUSIONS: Hepatectomy under selective PV occlusion seems to improve the recurrence-free survival in patients with HCC.     

Step classification is useful for the determination of indications for systematized hepatectomy in hepatocellular carcinoma

Background/Purpose The effectiveness of systematized hepatectomy with transection of Glisson's pedicle at the hepatic hilus has not been clarified in detail in relation to previous staging systems. Outcomes after systematized hepatectomy in patients with hepatocellular carcinoma (HCC) were examined in relation to our new staging system. Methods We retrospectively studied 955 patients with HCC who underwent hepatectomy from 1989 through 2002. We classified patients with HCC into four groups according to the pathological findings (pathological step [p-step]): p-step 1, HCC with absence of vascular invasion and absence of intrahepatic metastasis; p-step 2, HCC with vascular invasion and/or intrahepatic metastasis; p-step 3, HCC with major vascular invasion and/or intrahepatic metastasis to both lobes of the liver; and p-step 4, HCC with distant metastasis, including lymph node metastasis or ruptured HCC). We separated the liver into three segments (Takasaki's liver segments). Systematized hepatectomy was classified as systematized segmentectomy or larger resection, and partial segmentectomy. Segmentectomy refers to resection of one of Takasaki's segments. Results Systematized segmentectomy did not affect recurrence-free survival, by univariate analysis, in patients with p-step 1, p-step 3, or p-step 4. However, systematized segmentectomy or larger resection was significantly associated with patient recurrence-free survival, by univariate analysis, in patients with p-step 2. Multivariate analysis also showed systematized segmentectomy or larger resection as a significant independent prognostic factor in patients with p-step 2. Conclusions Systematized segmentectomy is suitable for patients with p-step 2 HCC according to this step classification.     

Role of a hepatectomy for the treatment of large hepatocellular carcinomas measuring 10 cm or larger in diameter

BACKGROUND: A curative hepatectomy is the mainstay of effective treatment for small hepatocellular carcinoma (HCC), but the treatment of large HCC remains challenging. MATERIALS AND METHODS: The possible prognostic factors were retrospectively analyzed in 85 patients with large HCC (>/=10.0 cm) who all underwent a hepatectomy for HCC between 1988 and 2004. A survival analysis was made by classifying the tumors into four spreading patterns according to the number of tumors and the presence of macroscopic tumor thrombus. RESULTS: A positive hepatitis B antigen, the earlier period of hepatectomy, a non-curative hepatectomy, multiple tumors, and portal vein invasion were identified as independent predictors of a poor prognosis. The median survival term and 5-year survival rate of patients with a solitary large HCC without a macroscopic tumor thrombus was 9.8 years and 69.8%, respectively. The tumor spreading patterns according to the number of tumors and the presence of a macroscopic tumor thrombus were statistically associated with a non-curative hepatectomy (p < 0.001). There was a statistical difference among 33 patients with large HCC undergoing a non-curative hepatectomy based on the presence of a macroscopic portal vein invasion (p = 0.0089). CONCLUSION: A hepatectomy could yield an excellent long-term survival in patients with a solitary large HCC without a macroscopic tumor thrombus. Even if a curative hepatectomy could not be achieved, a hepatectomy might provide better survival in large HCC patients without a macroscopic tumor thrombus compared in those with macroscopic tumor thrombus.     

Limited Hepatic Resection for Hepatocellular Carcinoma in the Caudate Lobe

The most appropriate approach to treating hepatocellular carcinoma (HCC) in the caudate lobe has not yet been determined. A series of 197 patients who had undergone curative hepatic resection for HCC were analyzed. Fifteen patients had HCC in the caudate lobe: three in the Spiegel lobe (SP), three in the caudate process (CP), and nine in the paracaval portion (PC). Patients with HCCs in the SP and CP underwent partial hepatectomy. HCCs in the PC were approached in one of three ways: anterior approach and partial hepatectomy of the PC (Ant+PHx-PC), partial hepatectomy, or left lobectomy. Clinicopathologic variables, including the underlying liver disease, the mean tumor size, and the pathologic characteristics of HCC, did not differ between surgery of the caudate lobe and that of other segments. The overall survival was 88.9% at 3 years and 66.7% at 5 years after resection of HCC in the caudate lobe; the corresponding figures were 86.1% at 3 years and 68.6% at 5 years for the other segments. The recurrence-free survival rate was 51.9% at 3 years and 34.6% at 5 years for the caudate lobe, and it was 52.1% at 3 years and 32.8% at 5 years for the other segments. Clinicopathologic characteristics of HCCs originating in the caudate lobe were not different from those in the other segments. Limited resection of HCC in the caudate lobe confers a similar prognostic value as in other segments.     

Surgical treatment of hepatocellular carcinoma in China

Background and aims Surgery remains the most effective treatment for hepatocellular carcinoma (HCC). While resection and liver transplantation achieve the best outcomes in patients with small HCC, controversy surrounds treatment of large HCC, HCC with portal vein tumor thrombus, and HCC with hypersplenism.Patient/methods From January 1988 to December 2002, 2,102 patients with large HCC underwent hepatectomy in our hospital. The traditional resection method was used on 959 patients, after which the improved new method was used on 1,143 patients. Meanwhile, from January 1990 until December 2003, hepatic resection ± thrombectomie has been performed in 438 patients with HCC and portal vein tumor thrombus. Among them, 286 patients showed portal vein tumor thrombus located in the primary and secondary branch of the main portal vein (group A), and 152 patients showed portal vein tumor thrombus (PVTT) involved in the main portal vein (group B). Additionally, out of 204 HCC patients with cirrhotic hypersplenism, 94 patients had hepatectomy and splenectomy, and 100 patients had only hepatectomy without hospital death.Results The 3- and 5-year survival after resection of large HCCs (over 5 cm) with improved new method in China was between 50.7 and 58.8% and 27.9 and 38.7%, respectively. Tumor recurrence in the liver within 1 year after hepatic resection + thrombectomie was detected in 45% of group A and in 78.8% in group B. The cumulative 5-year overall survival rates were 18.1% for group A and 0% for group B. The 1-, 3-, and 5-year overall survival in HCC plus portal vein tumor thrombus (PVTT) was 58.7, 22.7, and 18.1%. The hepatectomy/splenectomy group had a 5-year tumor-free survival rate of 37.2% and the hepatectomy group alone had 27.2%.Conclusion The new resection methods, hepatic resection + thrombectomy and hepatectomy + splenectomy, are very effective treatments for large HCC, HCC with portal vein tumor thrombus, and HCC with hypersplenism, respectively. Local treatment modalities, e.g. percutaneous ethanol injection, cryosurgery, and radiofrequency ablation as well as microwave coagulation are used in patients with poor liver function in small and large HCCs.     

Determinants of long-term survival following hepatectomy for hepatocellular carcinoma, with special reference to patients surviving more than 10 years

To elucidate the determinants of survival and the clinicopathologic features of long-term survivors of resections for HCC, we reviewed 539 patients who had had hepatectomy alone or hepatectomy together with hepatic arterial ligation or ethanol injection for the treatment of hepatocellular carcinoma (HCC) at our department between 1973 and December 1992. Of these patients, 30% (79/264) survived for more than 5 years and 11% (10/87) for more than 10 years. All the long-term survivors had received curative resections. The 5- and 10-year survivors accounted for 58% (79/136) and 29% (10/35) of those with curative resections, respectively. Crucial determinants for long-term survival were the absence of portal invasion and satellite nodules, a diploid pattern of DNA content, and a curative resection. A curative resection for diploid HCCs led to much better survival rates (73%) at 5 years than such a resection for aneuploid HCCs (35%), and than for non-curative resections for aneuploid HCCs (0%). The history and tumor background of the ten patients who survived for more than 10 years were characterized by good reserve liver function, warranting a wider resection, predominance of female sex, single nodular growth, and the absence of poorly differentiated cells, in addition to the favorable conditions described above. Three of the ten patients developed a new lesion; these were successfully treated by re-resection or repeated arterial embolization, since they were confined to the remnant liver and showed single nodular growth without extranodular spread. This analysis indicates that hepatectomy is the option of first choice for HCC patients with the potential for cure and good reserve liver function.     

Laparoscopic hepatectomy for hepatocellular carcinoma

BACKGROUND: No reports exist on the role of laparoscopic hepatectomy in the short- and long-term outcomes of patients with hepatocellular carcinoma (HCC). We present our results from using laparoscopic hepatectomy for HCC and discuss the importance of this procedure. METHODS: To investigate the role of laparoscopic hepatectomy in the short- and long-term outcomes, 17 patients with HCC who underwent laparoscopic hepatectomy (laparoscopic hepatectomy group) were compared with 38 patients who underwent conventional open hepatectomy (open hepatectomy group) during the same period. RESULTS: No differences in operation time, blood loss, rate of blood transfusion, or incidence of postoperative complications were found between the two groups. The postoperative hospital stay for the laparoscopic hepatectomy group was significantly shorter than for the open hepatectomy group. With long-term prognosis, no difference was found in survival rate and disease-free survival rate between the two groups. No recurrence was found in the stump of the remaining liver after laparoscopic hepatectomy. CONCLUSIONS: Laparoscopic hepatectomy has resulted in a better short-term outcome after surgery than conventional open hepatectomy. The long-term prognosis in the laparoscopic hepatectomy group was similar to that in the open hepatectomy group. Therefore, laparoscopic hepatectomy can be a new alternative for treatment of cirrhotic patients with HCC when patients are strictly selected.     

Prognostic impact of treatment modalities on patients with single nodular recurrence of hepatocellular carcinoma

Purpose  To evaluate the prognostic impact of various therapeutic modalities, such as repeat hepatectomy, ablation therapy, and transcatheter arterial chemoembolization (TACE) therapy, used to treat single nodular recurrent hepatocellular carcinoma (HCC). Methods  Thirty-two patients with single nodular intrahepatic recurrence after curative primary resection of HCC were enrolled in this study. The prognostic factors after recurrence were established using 13 clinicopathologic variables, including the therapeutic modalities; namely, repeat hepatectomy, ablation therapy, or TACE therapy. Results  Of the 32 patients, 9 underwent repeat hepatectomy, 10 underwent ablation therapy, and 13 underwent TACE therapy. The therapeutic modality was the only prognostic factor. In comparison with TACE therapy, the relative risks associated with ablation therapy and repeat hepatectomy were 0.19 and 0.29, respectively. The 5-year survival rates after single nodular recurrence were 57% in the ablation therapy group, 29% in the repeat hepatectomy group, and 0% in the TACE therapy group. Conclusions  Repeat hepatectomy and ablation therapy are more effective than TACE therapy for improving the prognosis of patients with single nodular intrahepatic recurrent HCC.     

原发性肝癌门静脉癌栓患者合并肝门淋巴结转移手术疗效的比较研究

目的探讨原发性肝癌门静脉癌栓合并肝门淋巴结转移的手术疗效。方法 2001年1月～2003年12月28例肝癌伴门静脉癌栓术中发现肝门淋巴结肿大行肝门淋巴结清扫术,将有肝门淋巴结转移的15例设为淋巴结转移组,无肝门淋巴结转移的13例设为非淋巴结转移组,对2组患者的无瘤生存期和总生存期情况进行比较。结果淋巴结转移组生存2～13个月,中位生存期4个月,无瘤生存1～8个月,无瘤中位生存期3个月;非淋巴结转移组患者生存3～69个月,中位生存期11个月,无瘤生存2～32个月,无瘤中位生存期7个月。2组患者的无瘤生存期和总生存期有显著性差异（χ2=5.786,P=0.038;χ2=3.963,P=0.045）。结论伴有肝门淋巴结转移的原发性肝癌门静脉癌栓患者的手术疗效较差,即使行肝门淋巴结清扫也不能达到根治效果,并不能显著提高该病人的生存期。     

Results of surgical treatment for recurrent hepatocellular carcinoma; comparison of outcome among patients with multicentric carcinogenesis, intrahepatic metastasis, and extrahepatic recurrence

No consensus has been reached on the indications for and effectiveness of surgery for secondary intrahepatic hepatocellular carcinoma (HCC) and extrahepatic metastasis after macroscopically complete removal of primary HCC. Secondary intrahepatic HCCs, usually regarded as recurrence are classified into those arising as a result of multicentric carcinogenesis or intrahepatic metastases derived from the primary HCC. The present study was designed to evaluate the utility of surgical treatment in relation to the pathogenesis of the secondary HCC: classified as multicentric carcinogenesis (MC), intrahepatic metastasis (IM), and extrahepatic metastasis. Thirty patients underwent extirpation of secondary HCC: 22 patients had secondary HCCs in the remnant liver (MC group; n = 8; IM group, n = 14), 6 patients had extrahepatic metastases, and 2 patients had both intrahepatic and extrahepatic metastases. Survival rates after the re-resection in the 22 patients with the secondary intrahepatic HCCs were 94.7% at 1 year, and 50.2% at 3 years postoperatively, and the 8 patients with extrahepatic metastasis had survival rates of 62.5% at 1 year, 37.5% at 3 years, and at 5 years. The survival rates after re-resection in the MC group were 100% at 1 year and 80.0% at 3 years, whereas those in the IM group were 91.7% at 1 year, and 38.1% at 3 years. Surgery can be indicated not only in patients with localized intrahepatic secondary HCCs but also in those with extrahepatic metastasis. In particular, patients with secondary HCCs arising as a result of multicentric carcinogenesis are expected to have a good prognosis. Received for publication on Jan. 13, 1997; accepted on Aug. 22, 1997     

Appraisal of Surgical Treatment for Pulmonary Metastasis from Hepatocellular Carcinoma

The outcome of pulmonary metastasectomy of hepatocellular carcinoma (HCC) was appraised in this study. Twenty patients with pulmonary metastasis from HCCs undergoing pulmonary resection between 1990 and 2003 were included in this study. They had undergone curative treatment for the primary lesion and were candidates for a pulmonary metastasectomy for complete resection. Among the 20 patients, 13 died: 5 from hepatic failure, 5 from respiratory failure, and 2 from brain metastasis due to recurrence of the HCC. One patient died from cardiac failure without HCC recurrence. At the latest observation, three of the seven survivors were doing well without HCC recurrence, and others survived with recurrence. The overall survival rates after the initial lung surgery were 45.3% at 1 year and 23.8% at 3 years, respectively. The survival rates without recurrence were 32.4% at 1 year and 21.6% at 3 years, respectively. A Kaplan-Meier analysis showed that multiple lung surgeries and a negative histologic finding of the liver cut surface were favorable characteristics for survival without recurrence. In conclusion, the selected patients were Candidates for pulmonary metastasectomy after a curative hepatectomy for HCC and could benefit from the complete resection. Also, repeated pulmonary resections through thoracoscopy could result in the long-term survival of patients with pulmonary recurrence of HCC.     

Characteristics of multicentric hepatocellular carcinomas: comparison with intrahepatic metastasis

Characteristics of multicentric hepatocellular carcinomas (HCCs) remain obscure. We therefore aimed to clarify them and compare them with HCC with intrahepatic metastases. A series of 118 patients who had definite hepatitis C viral status and multinodular HCC were divided into two groups: a multicentric occurrence (MO) group (n= 38), with multicentric HCCs; and an intrahepatic metastasis (IM) group (n= 80), with HCC having intrahepatic metastases. Clinicopathologic variables, including the patient's survival and disease-free survival rates, were compared between the MO and IM groups. Univariate analysis revealed the presence of esophageal varices, the presence of hepatitis C virus infection, a platelet count of less than 10 × 10⁴/μl, hepaplastin test, γ-globulin, the histologically active hepatitis, tumor size, des-γ-carboxy prothrombin > 0.1 AU/ml, positive portal vein invasion, and histologic grade as discriminating factors. The MO score to differentiate multicentric HCCs from intrahepatic metastatic HCCs was determined using the following four independent factors selected by a stepwise regression analysis: the presence of hepatitis C virus infection, a platelet count of less than 10 × 10⁴/μl, tumor size, and histologic grade. The sensitivity and specificity of the MO scores using those factors were 84% and 70%, respectively, when the cutoff value was 0.4. The disease-free survival rate in the MO group was similar to that in the IM group, whereas the survival rate in the MO group was significantly better than that in the IM group. The multivariate analysis revealed the multicentric occurrence of HCC as one of the independent prognostic factors. Clinicopathologic factors differentiating multicentric HCCs from intrahepatic metastatic HCCs were the presence of hepatitis C virus infection, a platelet count of less than 10 × 10⁴/μl, small tumor size, and low histologic grade.     

Surgical treatment of advanced hepatocellular carcinoma]

One hundred and thirty-two patients with hepatocellular carcinoma in stages III and IV were studied. Seventy-six patients who underwent hepatectomy were divided into three groups: relative curative resection (RC: n = 30), relative noncurative resection (RNC: n = 30) and absolute noncurative resection (ANC: n = 16). Fifty-six patients were treated by non surgical procedures such as hepatic arterial infusion, transcatheter arterial embolization, ethanol injection and hyperthermia. The cumulative survival rate of hepatectomy patients was significantly better than that of non-surgically treated patients. The most significant prognostic factor was the presence of the portal venous invasion. In the patients without tumor thrombi or with tumor thrombi found microscopically, the cumulative survival rates of both RC and RNC were significantly better than those of ANC and non-surgically treated patients, but in the patients with tumor thrombi found grossly, there was no difference between hepatectomy patients and non-surgically treated patients. These results indicate that surgical treatment for advanced hepatocellular carcinoma improve the prognosis of the patients without tumor thrombi found grossly.     

Hepatic Resection for Hepatocellular Carcinoma with Obstructive Jaundice due to Biliary Tumor Thrombi

Hepatocellular carcinoma (HCC) with obstructive jaundice due to biliary tumor thrombi is uncommon, and few studies have examined the outcome of hepatectomy for HCC with this unusual entity. This study examined the clinicopathologic factors influencing the outcomes of 17 HCC patients with obstructive jaundice due to biliary tumor thrombi undergoing hepatectomy. The clinical features of 17 HCC patients with obstructive jaundice due to biliary tumor thrombi (group A) undergoing hepatectomy from 1986 to 1998 were reviewed. The clinical features and factors influencing the outcome of 555 HCC patients without biliary tumor thrombi (group B) undergoing hepatectomy were used for comparison. Of 572 patients with surgically resected HCCs, 17 (3.0%) were classified into group A. Right upper quadrant pain, physical signs of jaundice, low albumin level, elevated bilirubin level, small tumor size, more vascular invasion, and tumor rupture were characteristic of group A patients. Multivariate stepwise logistic regression analysis revealed no independently significant factor differentiating group A patients from group B patients. The disease-free survival was similar between the group A and B patients, although group B patients exhibited significantly better overall survival (p = 0.014). Vascular invasion may adversely influence overall survival in group A patients undergoing hepatic resection (p = 0.0709). When feasible, hepatic resection is the preferred treatment for HCC patients with obstructive jaundice due to biliary tumor thrombi. It can achieve a disease-free survival comparable to that of HCC patients without biliary tumor thrombi. However, HCC patients with biliary tumor thrombi had significantly worse overall survival than did those without biliary tumor thrombi, especially those with concomitant vascular invasion.     

Extended hepatic resection and outcomes in intrahepatic cholangiocarcinoma

Background/Purpose. The aim of this report was to assess the outcome of aggressive surgical treatment for intrahepatic cholangiocarcinoma. Methods. From 1984 to 2001, we encountered 64 patients with intrahepatic cholangiocarcinoma. Of the 64 patients, 50 patients who underwent surgical resection with macroscopically curative objectives (78%) were reviewed for surgical procedures and outcomes. Results. Hemi- or more extensive hepatectomy was required for surgical resection in 40 patients (80%). Overall hospital morbidity and mortality rates were 50% and 8%, respectively. Curative resection with pathological free margins was achieved in 34 patients (68%). The 1-, 3-, and 5-year patient survival and tumor-free survival rates were 61.6%, 37.6%, and 22.5%; and 55%, 11%, and 11%, respectively. Among the macroscopic types, all 9 patients with intraductal growth type are alive 11–75 months after surgery. Survival rates among patients who had undergone curative resection were significantly better than those in patients who had undergone noncurative resection, even when patients with the intraductal growth type were excluded. Nodal status did not affect patient survival. Conclusions. Although the overall survival rate after surgical resection remains unsatisfactory, long-term survival is possible through extended surgical resection with pathological free margins. Patients with the intraductal growth type of intrahepatic cholangiocarcinoma might have the best chance of being cured by surgical treatment.