Diagnostic and Therapeutic Problems in Patients with Combined Hepatocellular Carcinoma and Gastrointestinal Cancer

Hiromoto Shiki, Yonson Ku, Harumasa Ohyanagi, Yoichi Saitoh

First Department of Surgery, Kobe University School of Medicine

We reviewed the clinical records of 11 patients with combined hepatocellular carcinoma (HCC) and gastrointestinal cancer with special reference to the diagnostic and therapeutic problems. Five patients had gastric cancer and HCC synchronously. In the remaining six patients, three had gastric cancer and three had colorectal cancer metachronously. In the three patients with HCC as the first cancer detected, gastrointestinal cancers were incidentally found during endoscopic examination. On the other hand, in eight patients with gastrointestinal cancers as the first lesion detected. CT studies for screening for liver metastasis and elevation of serum α-fetoprotein (AFP) were major diagnostic clues to the diagnosis of HCC. In these patients, serum carcinoembryonic antigen (CEA) levels remained in the normal range except for three patients with slight elevation. Therefore, we consider that a negative CEA level accompanying a positive AFP level is of value for diagnosing combined HCC and gastrointestinal cancer. Six of the 11 patients had hepatectomy. Although two patients died of hepatic failure, four remain alive. In five patients with synchronous cancers, three had simultaneous resection of both HCC and gastric cancer. One of these three patients died of hepatic failure and leakage of the gastrojejunostomy one month after surgery. Based on these observations, we consider that the extent and the method of hepatic resection should be carefully determined according to a more strict preoperative assessment of the hepatic functional reserve. In addition, an accurate procedure for avoiding anastomotic leakage and stenosis is of particular importance during reconstruction of the gastrointestinal tract.

Key words
double cancer, hepatocellular carcinoma, gastrointestinal cancer, diagnostic and therapeutic problems

Reprint requests
Hiromoto Shiki First Department of Surgery, Kobe University School of Medicine
7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650 JAPAN

Accepted
April 1, 1992

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