Two-stages resection for advanced hepatocellular carcinoma

We performed two-stage resection for sixteen patients with advanced hepatocellular carcinoma from January, 1987 to July, 1991. All patients underwent various surgical therapies prior to resection which included gauze packing hemostasis in 1 case, hyperthermia plus radiotherapy in 1, hepatic arterial ligation in 2, operative hepatic arterial embolization in 3, and transcatheter embolization in 9. The median interval between the first therapy and tumour resection was 59 days with a range of 29--769 days, and the median diameter of tumours decreased from 10.5 cm to 7.5 cm. The majority of precedures on two-stage resection were irregular hepatectomy or Iobectomy under occlusion of porta hepatis. Regular hepatectomies were done in 4 cases. Pathalogical examination showed complete coagulation necrosis in 3 specimens. However, in the others were still found residual viable tumours. Survival periods of the patients who received two-stage resection were from 4 months to 4 years except 2 operative death. The significance, possibility as well as methods of two-stage resection were discussed.     

TWO－STAGE RESECTION FOR ADVANCED HEPATOCELLULAR CARCINOMA─PRELIMINARY RESULTS OF 16 CASES

ＴＷＯ－ＳＴＡＧＥＲＥＳＥＣＴＩＯＮＦＯＲＡＤＶＡＮＣＥＤＨＥＰＡＴＯＣＥＬＬＵＬＡＲＣＡＲＣＩＮＯＭＡ─ＰＲＥＬＩＭＩＮＡＲＹＲＥＳＵＬＴＳ　ＯＦ１６ＣＡＳＥＳＬｉａｎｇＬｉｊｉａｎ；Ｌｕｍｉｎｇｄｅ；ＨｕａｎｇＪｉｅｆｕ；ＰｅｎｇＢａｏｇａｎｇ梁...     

Pathological evaluation of hepatic dearterialization in encapsulated hepatocellular carcinoma

Specimens of encapsulated hepatocellular carcinoma from 48 patients who had received no previous treatment and from six patients previously treated by hepatic arterial interruption by embolization or ligation were obtained by resection and examined for incidence and extent of necrosis of the tumor. Among the 48 specimens from the non-pre-treated patients, 25 tumors were smaller than 5 cm and showed no notable necrosis; of the 23 remaining tumors--which were larger than 5 cm--12 (52%) showed spontaneous central necrosis. The necrosis rate of the tumor ranged from 10% to 40%. In contrast, in six specimens from pretreated cases, more than 60% of the tumors were found to be necrotic. Two tumors smaller than 5 cm were completely necrotized by embolization. The findings indicated the significance of hepatic dearterialization for the management of encapsulated hepatocellular carcinoma. Daughter nodules, however, were found to have escaped necrosis.     

Histologic assessment of resected hepatocellular carcinoma after transcatheter hepatic arterial embolization

Ten cases of large hepatocellular carcinoma (HCC) (largest diameter, 6.5-15 cm) were surgically resected from 3 to 19 days after transcatheter hepatic arterial embolization (TAE) for histologic assessment of the effectiveness. Another two patients, including one with a small HCC (3.5 X 3 X 3 cm) who died of complications, were also studied. The patients' ages ranged from 20 to 64 years, 11 were men and 1 was a woman, and all positive for serum hepatitis B surface antigen. All 11 cases with large HCC were symptomatic before the HCC was clinically diagnosed. Alpha-fetoprotein levels were elevated in ten cases but immediately dropped to normal levels after TAE and resection in eight cases. An effective massive tumor coagulative necrosis of 99% already occurred 3 days after TAE. A necrosis involving more than 95% of the whole tumor mass was demonstrated in eight cases: one was a large HCC taken from an autopsy specimen, and TAE was done three times. This strongly indicates the effectiveness of TAE on the destruction of HCC. However, the presence of viable residual tumors in 11 cases also strongly argues for the necessity for surgical resection whenever it is possible. The failure of a complete necrosis was related to the extracapsular extension, liver invasion, satellite nodules, and portal vein involvement, and probably related to collateral and portal vein blood supply.     

肝动脉插管化疗栓塞治疗中晚期肝癌及其并发症的防治

我们运用导管法治疗６５例中晚期肝癌，巨块型占６１．３％，结节型占２６．１％，弥漫型占２１．６％，患者肿瘤直径约３ｃｍ～１８ｃｍ不等。随访６－３３个月，多数患者治疗后肿瘤缩小，单纯灌注化疗组１２个月生存率为６．６％，化疗＋碘油＋明胶海绵生存率最高为３７．５％，最长的１例，生存３０个月。影响疗效的因素有：（１）肿瘤分期，（２）门静脉癌栓，（３）肝动脉治疗方法。并探讨治疗后并发症的产生原因和预防措施。     

Particle embolization of recurrent hepatocellular carcinoma after hepatectomy

BACKGROUND: Complete surgical resection is the mainstay of treatment for patients with hepatocellular carcinoma (HCC). Unfortunately, most patients ultimately develop disease recurrence and the median survival from the time of recurrence is <1 year. The purpose of the current study was to review the authors' experience using bland hepatic arterial embolization to treat recurrent HCC after definitive surgical resection. METHODS: The authors reviewed their single-center hepatic embolization database from 1995 through 2004 to identify patients who underwent bland hepatic arterial embolization for disease recurrence. Data analyzed included patient demographics, Okuda stage and Child score, imaging findings, and embolization variables. Recurrence-free survival (from surgery to disease recurrence) and survival time (from recurrence to last follow-up) were calculated using the Kaplan-Meier method. RESULTS: The authors identified 45 patients treated with bland embolization for recurrent HCC after resection. Six patients also underwent ablative therapy after embolization. Of the 45 patients, 42 (93.3%) patients had Okuda Stage 1 disease. The median time to recurrence was 13 months. The median survival after embolization was 46 months, and actuarial survival rates at 1 year, 2 years, and 5 years after recurrence were 86%, 74%, and 47%, respectively, with a median follow-up of 31 months. Patients who developed disease recurrence with a solitary lesion had a significantly improved survival (P = .03) At the time of last follow-up, 3 patients (6.6%) were alive with no evidence of viable disease. CONCLUSIONS: Bland arterial embolization was found to be an effective method of salvage therapy for patients with good liver function with recurrent HCC after prior surgical resection. Patients whose disease recurred with a solitary lesion appear to have a significantly increased survival compared with patients who develop disease recurrence with multiple tumors. A small proportion of patients can be rendered without evidence of viable disease.     

Radiofrequency ablation of primary and metastatic hepatic malignancies

The majority of patients with primary of metastatic hepatic tumors are not candidates for resection, because of tumor size, location near major intrahepatic blood vessels precluding a margin-negative resection, multifocality, or inadequate hepatic function related to coexistent cirrhosis. Radiofrequency ablation (RFA) is an evolving technology being used to treat patients with unresectable primary and metastatic hepatic cancers. RFA produces coagulative necrosis of the tumor through local tissue heating. Liver tumors are treated percutaneously, laparoscopioally, or during laparotomy, using ultrasonography to identify tumors and to guide placement of the RFA needle electrode. For tumors smaller than 2.0 cm in diameter, one or two deployments of the monopolar multiple-array needle electrode are sufficient to produce complete coagulative necrosis of the tumor. However, with increasing size of the tumor, there is a concomitant increase in the number of deployments of the needle electrode and the overall time necessary to produce complete coagulative necrosis of the tumor. In general, RFA is a safe, well-tolerated, effective treatment for unresectable hepatic malignancies less than 6.0 cm in diameter. Effective treatment of larger tumors awaits the development of more powerful, larger array monopolar and bipolar RFA technologies. Received: January 7, 2002     

肝动脉栓寒术治疗原发性肝癌的初步报告

Twenty patients with primary hepatic carcinoma (PHC) treated by hepatic arterial embolization in our department from Dec. 1986 to Mar. 1987 are reported. There were 15 males and 5 females. The ages ranged from 34 to 75 years with an average of 50.7. Preoperative diagnosis and localization of the tumor were done by AFP, B-us, CT and angiography (right lobe 15 cases, left lobe 1 case, both lobes 4 cases). Celiac and superior mesenteric angiography was carried out by femoral artery approach and then highly selective hepatic catheterization was utilized for hepatic arterial embolization. Antitumor agent (5-Fu, adriamycin), iophendylate and foamy gel sponge were used for peripheral and proximal embolization. Manifestations were improved in most of the patients after embolization, such as relief of abdominal pain, improvement of appetite, decrease of tumor size. Total necrosis of the tumor was found in 2 patients who underwent surgery 1 month after embolization. The side effects of the posthepatic embolization such as, nausea, vomiting, abdominal pain and fever could be relieved by symptomatic treatment. No severe complications, such as gangrene of the gall bladder, hepatic failure, liver abscess, intestinal necrosis or pulmonary embolization were found except 3 patients who died of renal failure after the procedure. The liver dys-function returned to normal within 2 weeks. Hepatic arterial embolization provides an alternative treatment for the patients with PHC who has compensated liver function without severe systemic diseases, especially renal endocrine problems and severe portal hypertension. They should have patent portal system as proved by angiography. The authors considered that this therapeutic embolization with hepatic chemotherapy infusion is safe and effective in the management of PHC. It may increase the resectability and provide palliative means for the advanced and terminal cases.     

超常规剂量碘油超选择TAE与常规TAE后Ⅱ期肝癌切除-27例手术病理及随访研究

目的评价术前应用超常规剂量碘油超选择TAE与常规TAE治疗原发性肝癌的价值。方法1987年8月～1999年12月12年间27例原发性肝癌分为两组治疗组17例,应用常规导管或球囊导管超选择至肿瘤供血动脉,阻断其血流,使注射碘油时不产生逆流,将全部动脉肿瘤血管、病变周围正常的小动脉及肝实质和门静脉分支栓塞,栓后25天～121天手术切除;对照组10例,应用一般导管,常规剂量的碘油超选或不超选栓塞肿瘤供血动脉,栓后20天～140天手术切除。对两组病人切除的标本均进行了详细的病理学研究,同时对全部病人随访3～8年。结果治疗组17例中11例肿瘤100%坏死,其余6例坏死率为85%～95%,3、5年生存率分别为88.2%(15/17)、45.5%(5/11),3例现生存6～8年;对照组10例中2例肿瘤完全坏死,另8例坏死率为75%～95%,3、5年生存率分别为60.0%(6/10)、14.3%(1/7)。结论术前应用超常规剂量碘油超选择TAE治疗原发性肝癌效果明显好于常规TAE。     

Hepatic metastasectomy in children

BACKGROUND: There are little data regarding the safety and efficacy of hepatic metastasectomy for solid tumors in childhood. We reviewed our institutional experience to assess operative mortality and morbidity, technique of resection, local control, and survival in pediatric patients undergoing liver resection for metastases. METHODS: All pediatric patients who underwent hepatic resection for metastatic disease from August 1988 to July 2005 were retrospectively identified and clinical data were collected. RESULTS: Fifteen patients were identified during this period and primary malignancies included neuroblastoma (7), Wilms tumor (3), osteogenic sarcoma (2), malignant gastric epithelial tumor (1), and desmoplastic small round cell tumor (2). Twelve patients underwent anatomical hepatic resections and 3 had wedge resections. There were no intraoperative or postoperative deaths. The 2 postoperative complications included 1 wound infection and 1 bile collection. The median follow-up after hepatic resection was 1.6 years (0.2-7 years). Three patients remain alive. Eleven patients died of progressive disease; 4 patients suffered local recurrence. One patient died from enterocolitis and sepsis and was without evidence of malignancy at the time of death. CONCLUSIONS: Hepatic metastasectomy in children is feasible and is associated with a low operative mortality and morbidity. In this small group of patients anatomic hepatectomy was associated with better local control compared with wedge resection. Overall prognosis in these patients remains poor and the decision to perform hepatic metastasectomy should be highly selective.