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Operative results in 143 patients with hepatocellular carcinoma

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Abstract

A total of 143 patients who underwent hepatic resection for hepatocellular carcinoma in our department were reviewed. The review was conducted for two periods: 1970–1982 (early period) and 1983–1990 (late period), that is, the periods before and after introduction of the hepatic surgical technique involving the use of a microwave tissue coagulator and ultrasonic dissector. One patient underwent extended lobectomy, 12 lobectomy, 9 segmentectomy, and 26 partial hepatectomy during the early period. Two patients underwent extended lobectomy, 7 lobectomy, 9 segmentectomy, 36 subsegmentectomy, and 41 partial hepatectomy during the late period. Operative mortality and hospital mortality were 16.7% and 22.9% during the early period and 1.1% and 8.4% during the late period, respectively. The overall mortality rate was significantly lower during the late period than during the early period. Postoperative complications developed in 62.5% of the patients with hepatic resection during the early period and in 48.4% of the patients during the late period. The size of tumors during the early period was significantly greater than that during the late period. Intraoperative blood loss during the late period was significantly lower than that during the early period. The survival curve was better among patients who underwent hepatic resection during the late period than among those during the early period. The satisfactory results during the late period are due to the introduction of intraoperative ultrasonography, microwave tissue coagulation, and ultrasonic dissection for hepatic surgery.

Résumé

Les dossiers de 143 patients ayant eu une résection hépatique pour carcinome hépatocellulaire ont été analysés. Deux périodes d'observation ont été comparées: la première entre 1970 et 1982 et la seconde entre 1983 et 1990, la limite étant déterminée par l'utilisation de la coagulation par micro-onde d'une part et le bistouri à ultra-sons, d'autre part. Pendant la première période, les interventions pratiquées ont été une lobectomie étendue dans un cas, 12 lobectomies simples, 9 segmentectomies, et 26 hépatectomies partielles. Pendant la seconde période, ont été pratiquées deux lobectomies étendues, 7 lobectomies simples, 9 segmentectomies, 36 sous-segmentectomies et 41 hépatectomies partielles. Les mortalité opératoire et hospitalière ont été respectivement de 16.7% et 22.9%, et de 1.1% et 8.4% dans les deux périodes d'observation. La mortalité globale était significativement plus basse pendant la deuxième période par rapport à la première. Les complications postopératoires ont été de 62.5% et de 48.4% dans les deux périodes d'observation. La perte sanguine peropératoire a été considérablement moindre pendant la deuxième période. L'amélioration des résultats de la chirurgie hépatique après 1983 est directement liée à l'introduction de l'échographie peropératoire, la coagulation par microondes et le bistouri à ultra-sons.

Resumen

Se revisaron 143 pacientes sometidos a resección hepática por carcinoma hepatocelular en nuestro departamento. La revisión fue realizada sobre dos periodos, de 1970 a 1982 (primer periodo) y de 1983 a 1990 (segundo periodo), correspondientes a los periodos antes y después de la introducción de las técnicas de cirugía hepática que utilizan el coagulador tisular de microondas y el disector ultrasónico. En el primer periodo un paciente fue sometido a lobectomía ampliada, 12 a lobectomía, 9 a segmentectomía y 26 a hepatectomia parcial. En el segundo periodo dos pacientes fueron sometidos a lobectomia ampliada, 7 a lobectomía, 9 a segmentectomía, 36 a subsegmentectomía y 41 a hepatectomía parcial. La mortalidad operatoria y la mortalidad hospitalaria fueron 16.7% y 22.9% en el primer periodo y 1.1% y 8.4% en el segundo, respectivamente. La tasa global de mortalidad apareció significativamente menor en el segundo periodo. El tamaño de los tumores fue significativamente mayor en el primer periodo. La pérdida intraoperatoria de sangre fue significativamente menor en el segundo periodo. La curva de sobrevida fue mejor en los pacientes del segundo periodo. Los satisfactorios resultados registrados en el segundo periodo se deben a la introduccion de la ultrasonografía intraoperatoria, de la coagulacion tisular de microondas y del disector ultrasónico en la cirugía hepática.

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Correspondence to Tohru Segawa M.D..

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Segawa, T., Tsuchiya, R., Furui, J. et al. Operative results in 143 patients with hepatocellular carcinoma. World J. Surg. 17, 663–667 (1993). https://doi.org/10.1007/BF01659138

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Keywords

  • Late Period
  • Early Period
  • Hepatic Resection
  • Partial Hepatectomy
  • Periodo