A Role of Surgery in the Treatment of Hepatocellular Carcinoma

Eizo Okamoto, Naoki Yamanaka, Ziro Fujimoto

First Department of Surgery, Hyogo College of Medicine

This report describes a contribution of surgical therapy in the treatment of hepatocellular carcinomas. The 589 patients who had surgical therapies during 1973 and Dec. 1989 consituted the present study. Hepatic resection should be the first option for patients with potential curability in view of the fact that the curative resection group achieved a 5 year survival rate of 60% in contrast to 6% in the non-curative group. Especially tumors with desired conditions such as no vascular invasion, no daughter lesion and a tumor size of less than 5 cm must be subjected to resection with which a 5 year survival of 91% can be expocted. In terms of indication of hepatectomy for advanced cancers untreatable with non-resection therapy as embolization or ethanol injection, a biological aspect of tumor nuclear DNA content is an useful guiding factor. When tumors are determined to be a diploid DNA pattern reductive resection combined with non-resection therapy is recommended. On the contrary it is not recommended for advanced cancers with an aneuploid pattern because of very limited prognosis. Determination of DNA ploidy pattern using needle biopsy specimen has made it possible to select treatable patients prior to surgery. In conclusion resection should be indicated under the consideration of curability and tumor DNA content.

Key words
hepatocellular carcinoma, hepatic resection, nuclear DNA content

Reprint requests
Eizou Okamoto First Department of Surgery, Hyogo College of Medicine
1-1 Mukogawa-cho, Nishinomiya, 663 JAPAN

Accepted
May 8, 1990

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