Surgical Treatment of Hepatocellular Carcinoma∼ A Rational Strategy Based on Therapeutic Outcome

Masanori Suzuki, Kenji Fukuhara, Michiaki Unno, Heigo Takeuchi, Naoki Sakurai, Hideaki Kodama, Masaya Oikawa and Seiki Matsuno

First Department of Surgery, Tohoku University School of Medicine

Establishment of the first entry therapy of hepatocellular carcinoma (HCC) requires a prospective randomized control study. However, these are some of the medical moral considerations that we must take into account. Hence, it is necessary a comparison between the therapeutic outcome of HCC patients among independent surgical and medical institutes of the same geographic region. We investigated the comparative cumulative survival outcomes evaluating retrospectively 107 HCC patients who underwent hepatic resection in our institute and 158 patients who underwent minimally invasive non-surgical treatments in the 3rd Department of Internal Medicine, Tohoku University School of Medicine since 1973, according to numbers of tumors, diameter of the main tumor and their clinical stages. The latter treatment consisted mainly of transcatheter arterial embolization therapy (TAE) and percutaneous ethanol injection therapy (PEI). Five-year survival rate in the hepatic resection group, with mean tumor diameter measuring up to 3.0cm and number of tumors less than three was 57.8%, that with solitary tumor diameter between 3.1 and 5.0 cm was 53.7% and that with mean tumor diameter over 5.1 cm was 37.0%. Even though the outcome of non-surgical treatments for HCCs has been gradually improving, these investigations revealed appreciably better results for the surgical approach compared to non-surgical minimally invasive therapy. For the HCC patients who have good liver function, the systematic and anatomical surgical hepatic resection results in more favorable long-term outcome with a superiority of the local curability than non-surgical treatments. Therefore, surgical resection should be considered the first entry therapy and represent the gold standard strategy for HCC therapy.

Key words
hepatocellular carcinoma, hepatectomy, TAE, PEI, surgical outcome of HCC

Reprint requests
Masanori Suzuki The First Department of Surgery, Tohoku University School of Medicine 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574 JAPAN

Accepted
January 27, 1999

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