A Study of the Tumor Wedge from Cut Stump at Hepatic Resection for Hepato-cellular Carcinoma and the Recurrence at Surgical Margin

Shojiro Miyazaki, Takeshi Takasaki, Toshiyuki Hayashi, Masakazu Yamamoto, Masashi Tsugita, Kouji Katsura, Takahumi Suzuki, Takehito Ohtsubo, Tetsuo Nakagami, Seiichiro Kobayashi, Fujio Hanyu

Department of Surgery, Institute of Gastroenterology, Tokyo women's Medical College

The relationship between the presence or absence of cancer infiltration of the liver incision surface and recurrence at the cut end was investigated in 106 patients who underwent hepatectomy for hepatocellular carcinoma. Seventy-one (67.0%) of the patients were TW (tumor wedge) positive. Recurrence in the remaining liver was observed in 37 (52.1%) of the TW positive patients and 16 (45.7%) of the TW negative patients. Recurrence at the cut end was observed in 4 (7.5%) of the 53 patients with recurrence in the remaining liver, and all 4 of these patients were TW positive. The incidence of recurrence in the remaining liver, 46.5%, among the TW positive patients, excluding the patients with recurrence at the cut end, was approximately equal to that in the TW negative patients, and the results of investigation in patients with recurrence at the cut end suggest that determination of TW can lead to an improvement in prognosis. With regard to the rate of survival without recurrence, however, there was no difference between TW positive and TW negative patients. This phenomenon was considered to depend on the circumstances, i.e., the significance of TW in recurrence is less than that of extracapsular infiltration, tumor embolism of the portal vein, intrahepatic metastasis and tumor size, since the incidence of recurrence at the cut end in patients with recurrence in the remaining liver was low. All of the patients with recurrence at the cut end showed a TW of 5 mm or less, suggesting that one of the scales by which TW can be determined is a TW of 5 mm or more.

Key words
recurrence at surgical margin, tumor wedge, hepatic resection, hepatocellular carcinoma

Reprint requests
Shojiro Miyazaki Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical College
8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JAPAN

Accepted
January 13, 1993

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