Advances in Surgical Treatment for Hepatocellular Carcinoma Over the Last 2O Years

Eizo Okamoto

First Department of Surgery, Hyogo College of Medicine

In the 20 years since the establishment of our Department of Surgery in 1973, 551 patients with hepatocellular carcinoma (HCC) have been treated by hepatectomy. Based on this experience results of clinical as well as basic studies on the pathogenesis of HCC and its surgical treatment have been accumulated. Approximately 90% of patients with HCC in Japan are associated with liver cirrhosis or precirrhotic chronic hepatitis, resulting in a high mortality rate after hepatectomy. A multiple regression equation predicting the safety limits of hepatectomy in patients with compromised liver function was devised at the end of 1980, after which the mortality rate for posthepatectomy liver failure fell rapidly to almost 0%. Since then, we have clarified that not the hepatic vein but the portal vein bears the draining system for HCC and that tumor hemodynamics together with elevated intratumoral pressure lead to the early development of intrahepatic metastasis. Based on these observations, we devised a new technique of anatomical segment- or subsegmentectomy preceeded by hilar ligation of portal pedicles. Portal vein invasion, intrahepatic metastasis and DNA ploidy patterns of HCC as well as the curability of applied hepatectomy were the cardinal factors that influenced the 5-year survival rate. However, curability itself was the main factor that influenced l0-year survival rate.

Key words
HCC with liver cirrhosis, prediction of the safe limits of hepatectomy, intrahepatic metastasis via portal vein, hepatectomy preceeded by suprahilar ligation of portal pedicles, DNA ploidy pattern

Reprint requests
Eizo Okamoto First Department of Surgery, Hyogo College of Medicine
1-1 Mukogawacho, Nishinomiya, 663 JAPAN

Accepted
June 14, 1993

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