Abstract
Background and aims
Surgery remains the most effective treatment for hepatocellular carcinoma (HCC). While resection and liver transplantation achieve the best outcomes in patients with small HCC, controversy surrounds treatment of large HCC, HCC with portal vein tumor thrombus, and HCC with hypersplenism.
Patient/methods
From January 1988 to December 2002, 2,102 patients with large HCC underwent hepatectomy in our hospital. The traditional resection method was used on 959 patients, after which the improved new method was used on 1,143 patients. Meanwhile, from January 1990 until December 2003, hepatic resection ± thrombectomie has been performed in 438 patients with HCC and portal vein tumor thrombus. Among them, 286 patients showed portal vein tumor thrombus located in the primary and secondary branch of the main portal vein (group A), and 152 patients showed portal vein tumor thrombus (PVTT) involved in the main portal vein (group B). Additionally, out of 204 HCC patients with cirrhotic hypersplenism, 94 patients had hepatectomy and splenectomy, and 100 patients had only hepatectomy without hospital death.
Results
The 3- and 5-year survival after resection of large HCCs (over 5 cm) with improved new method in China was between 50.7 and 58.8% and 27.9 and 38.7%, respectively. Tumor recurrence in the liver within 1 year after hepatic resection + thrombectomie was detected in 45% of group A and in 78.8% in group B. The cumulative 5-year overall survival rates were 18.1% for group A and 0% for group B. The 1-, 3-, and 5-year overall survival in HCC plus portal vein tumor thrombus (PVTT) was 58.7, 22.7, and 18.1%. The hepatectomy/splenectomy group had a 5-year tumor-free survival rate of 37.2% and the hepatectomy group alone had 27.2%.
Conclusion
The new resection methods, hepatic resection + thrombectomy and hepatectomy + splenectomy, are very effective treatments for large HCC, HCC with portal vein tumor thrombus, and HCC with hypersplenism, respectively. Local treatment modalities, e.g. percutaneous ethanol injection, cryosurgery, and radiofrequency ablation as well as microwave coagulation are used in patients with poor liver function in small and large HCCs.
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References
Lau WY, Ho S, Leung TWT, Chan M, Ho R, Johnson PJ, Li AK (1998) Selective internal radiation therapy for non-resectable hepatocellular carcinoma with intraarterial infusion of yttrium-90 microspheres. Int J Radiat Oncol Biol Phys 40:583–592
Chen XP, Qiu FZ (1983) Current status of the surgical management of primary liver cancer in China. Acta Acad Med Wuhan 3:60–64
Chen XP, Wu ZD, Qiu FZ (2000) The history, present and prospect of the surgical treatment of primary liver cancer in China. Chin J Bases Clin Gen Surg 7:257–258
Wu MC (2002) Clinical and experimental research of primary liver cancer in China. Chin-German J Clin Oncol 1:1–4
Llovet JM, Fuster J, Bruix J (1999) Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 39:1434–1440
Takayama T, Makuuchi M, Hirohashi S, Sakamoto M, Yamamoto J, Shimada K, Kosuge T, Okada S, Takayasu K, Yamasaki S (1998) Early hepatocellular carcinoma as an entity with high rate of surgical cure. Hepatology 28:1241–1246
Fong Y, Sun RL, Jarnagin W, Blumgart LH (1999) An analysis of 412 cases of hepatocellular carcinoma at a western center. Ann Surg 229:790–799
Yao FY, Ferrell L, Bass NM, Watson JJ, Baccetti P, Venook A, Ascher NL, Roberts JP (2001) Liver transplantation for hepatocellular carcinoma: expansion of tumor size limits does not adversely impact survival. Hepatology 33:1394–1403
Chen XP, Qiu FZ, Wu ZD, Zhang BX (2004) Chinese experience with hepatotectomy for huge hepatocellular carcinoma. Br J Surg 91:322–326
Chen XP, Wu ZD, Qiu FZ (1984) An experimental study of the longest tolerable time of the total portal tried occlusion in normothermia in rabbits. Chin J Surg 3:153–155
Chen XP, Wu ZD, Qiu FZ (1989) Clinical observation of long time of the total portal tried occlusion in normothermia in 81 cases. Chin J Surg 9:523–524
Launois B (2000) The intrahepatic glissonian approach to liver resection. In: Blumgart LH, Fong Y (eds) Surgery of the Liver and Biliary Tract. Saunders, London, pp 1698–1703
Chen XP, Wu ZD, Qiu FZ (1999) Right hemihepatectomy of directly tie off afferent and efferent hepatic vessels of the tumor-bearing liver. Chin J Pract Surg 19:678–679
Ando E, Tanaka M, Yamashita F, Kuromatsu R, Yutani S, Fukumori K, Sumie S, Yano Y, Okuda K, Sata M (2002) Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis. Cancer 95:588–595
Llovet JM, Bustamante J, Castells A, Vilana R, Aguso Mdel C, Sala M, Bru C, Rodes J, Bruix J (1999) Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 29:62–67
Yamada K, Izaki K, Sugimoto K, Magahara H, Morita Y, Yoden E, Matsumoto S, Soejima T, Sugimura K (2003) Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 57:113–119
Yamada R, Sato M, Kawabata M, Nakatsuka H, Nakamura K, Takashima S (1983) Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology 148:397–401
Lee HS, Kim JS, Choi IJ, Chung JW, Park JH, Kim CY (1997) The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal obstruction. A prospective controlled study. Cancer 79:2087–2093
Livraghi T, Grigioni W, Mazziotti A, Sangalli G, Vettori C (1990) Percutaneous ethanol injection of portal thrombosis in hepatocellular carcinoma: a new possible treatment. Tumor 76:394–397
Sitzmann JV, Abrams R (1993) Improved survival for hepatocellular carcinoma with combination surgery and multimodality treatment. Ann Surg 217:149–154
Yamanaka N, Okamoto E, Fujihara S, Kato T, Fujimoto J, Oriyama T, Mitsunobu M, Toyosaka A, Uematsu K, Yamamoto K (1992) Do the tumor cells of hepatocellular carcinoma dislodge into the portal venous system during hepatic resection? Cancer 70:2263–2267
Yamanaka N, Okamoto E, Toyosaka A, Mitunobu M, Fujihara S, Kato T, Fujimoto J, Oriyama T, Furukawa K, Kawamura E (1990) Prognostic factors after hepatectomy for hepatocellular carcinomas. A univariate and multivariate analysis. Cancer 65:1104–1110
Shimada M, Takenaka K, Kawahara N, Kajiyama K, Yamamoto K, Shirabe K, Nishizaki T, Yanaga K, Sugimachi K (1996) Surgical treatment strategy for patients with stage hepatocellular carcinoma. Surgery 119:517–522
Fuster J, Garcia-Valdecasas JC, Grande L, Tabet J, Bruix J, Anglada T, Taura P, Lacy AM, Gonzalez X, Vilana R, Bru C, Sole M, Visa J (1996) Hepatocellular carcinoma and cirrhosis. Results of surgical treatment in a European series. Ann Surg 223:297–302
Fong Y, Sun RL, Jarnagin W, Blumgart LH (1999) An analysis of 412 casses of hepatocellular carcinoma at a western center. Ann Surg 229:790–800
Ikai I, Yamaoka Y, Yamamoto Y, Ozaki N, Sakai Y, Satoh S, Shinkura N, Yamamoto M (1998) Surgical intervention for patients with stage—a hepatocellular carcinoma without lymph node metastasis: proposal as a standard therapy. Ann Surg 227:433–439
Izumi R, Shimizu K, Ii T, Yagi M, Matsui O, Nonomura A, Miyazaki I (1994) Prognostic factors of hepatocellular carcinoma in patients undergoing hepatic resection. Gastroenterology 106:720–727
Fujii T, Takayasu K, Muramatsu Y, Moriyama N, Wakao F, Kosuge T, Takayama T, Makuuchi M, Yamasaki S, Okazaki N (1993) Hepatocellular carcinoma with portal tumor thrombus: analysis of factors determining prognosis. Jpn J Clin Oncol 23:105–109
Hirai K, Kawazoe Y, Yamashita K, Kumagai M, Tanaka M, Sakai T, Inoue R, Eguchi S, Majima Y, Abe M (1986) Transcatheter partial splenic arterial embolization in patients with hypersplenism: a clinical evaluation as supporting therapy for hepatocellular carcinoma and liver cirrhosis. Hepatogastroenterology 33:105–108
Lokich J, Costello P (1983) Splenic embolization to prevent dose limitation of cancer chemotherapy. Am J Roentgenol 140:159–161
Yoshimi F, Meigata K, Nagao T, Fukushima S, Uchida H, Wakabayashi T (1994) Hepatocellular carcinoma with a solitary adrenal metastasis and poor hepatic functional reserve: report of a case. Surg Today 24:268–271
Shimada M, Hashizume M, Shirabe K, Takenaka K, Sugimachi K (2000) A new surgical strategy for cirrhotic patients with hepatocellular carcinoma and hypersplenism: performing a hepatectomy after a laparoscopic splenectomy. Surg Endosc 14:127–130
Yoshimi F, Meigata K, Nagao T, Fukushima S, Uchida H, Wakabayashi T (1994) Hepatocellular carcinoma with a solitary adrenal metastasis and poor hepatic functional reserve: report of a case. Surg Today 24:268–271
Sugawara Y, Yamamoto J, Shimada K, Yamasaki S, Kosuge T, Takayama T, Makuuchi M (2000) Splenectomy in patients with hepatocellular carcinoma and hypersplenism. J Am Coll Surg 190:446–450
Aoe T, Okamoto Y, Saito T (1995) Activated macrophages induce structural abnormalities of the T cell receptor-CD3 complex. J Exp Med 181:1881–1886
Ringe B, Pichlmayr R, Wittekind C, Tusch G (1991) Surgical treatment of hepatocellular carcinoma: experience with liver resection and transplantation in 198 patients. World J Surg 15:270–285
Iwatsuki S, Gordon RD, Shaw BW Jr, Starzl TE (1985) Role of liver transplantation in cancer therapy. Ann Surg 202:401–407
O’Grady JG, Polson RJ, Rolles K, Calne RY, Williams R (1988) Liver transplantation for malignant disease. Results in 93 consecutive patients. Ann Surg 207:373–379
Ismail T, Angrisani L, Gunson BK, Hubscher G, Buckels JAC, Neuberger JM, Elias E, McMaster P (1990) Primary hepatic malignancy. The role of liver transplantation. Br J Surg 77:983–987
Pichlmayr R, Weimann A, Ringe B (1994) Indications for liver transplantation in hepatobiliary malignancy. Hepatology 20:33S–40S
Bismuth H, Chiche L, Castaing D (1995) Surgical treatment of hepatocellular carcinomas in non-cirrhotic liver: experience with 68 liver resections. World J Surg 19:35–41
Schwartz M, Sung M, Mor E, Fisher A, Popescu I, Fiel I, Sheiner P, Emre S, Guy S, Miller CM (1995) A multidisciplinary approach to hepatocellular carcinoma in patients with cirrhosis. J Am Coll Surg 180:596–603
Mazzafero V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, Montalto F, Ammatuna M, Morabtto A, Gennari L (1996) liver transplantation for the treatment of small hepatocellular carcinoma in patients with cirrhosis. N Engl J Med 334:693–699
Mcpeake JR, O’Grady JG, Zaman S, Portmann B, Wight DGD, Tan KC, Calne RY, Williams R (1993) liver transplantation for primary hepatocellular carcinoma: tumor size and number determine outcome. J Hepatol 18:226–234
Dmitrewski J, El-Gazzaz G, McMaster P (1998) Hepatocellular cancer: resection or transplantation. J Hepatol Bil Pancr Surg 5:18–23
Castells A, Bruix J, Bru C, Ayuso C, Roca M, Boix L, Vilane R, Rodes J (1993) Treatment of small hepatocellular carcinoma in cirrhotic patients: a cohort study comparing surgical resection and percutaneous ethanol injection. Hepatology 18:1121–1126
Ohnishi K (1998) Comparison of percutaneous acetic acid injection and percutaneous ethanol injection for small hepatocellular carcinoma. Hepatogastroenterology 45:1254–1258
Adam R, Akpinar E, Johann M, Kunstlinger F, Majno P, Bismuth H (1997) Place of cryosurgery in the treatment of malignant liver tumors. Ann Surg 225:39–50
Zhou XD, Tang ZY (1998) Cryotherapy for primary liver cancer. Semin Surg Oncol 14:171–174
Pearson AS, Izzo F, Fleming D, Ellis LM, Delrio P, Roh MS, Granchi J, Curley SA (1999) Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies. Am J Surg 178:592–599
Buscarini L, Rossi S (1997) Technology for radiofrequency thermal ablation of liver tumors. Semin Laparosc Surg 4:96–101
Murakami R, Yoshimatsu S, Yamashita Y, Matsukawa T, Takahashi M, Sagara K (1995) Treatment of hepatocellular carcinoma: value of percutaneous microwave coagulation. AJR Am J Roentgenol 164:1159–1164
Song SB, Zhang TL, Xiu DR, Yuan J, Wang DC, Jiang B, Wang CM (2004) Effective evaluation of liver transplantation for hepatocellular carcinoma. Zhonghua Yi Xue Za Zhi 84:1533–1535
Xu X, Zheng SS, Liang TB, Wang WL, Jin J, Shen Y, Wu J, Yu J (2004) Orthotopic liver transplantation for patients with hepatocellular carcinoma complicated by portal vein tumor thrombi. Hepatobiliary Pancreat Dis Int 3:341–344
Zhao JC, Lu SC, Yan LN, Li B, Wen TF, Zeng Y, Cheng NS, Wang J, Luo Y, Pen YL (2003) Incidence and treatment of hepatic artery complications after orthotopic liver transplantation. World J Gastroenterol 9:2853–2855
Chen ZS, Zeng FJ, Ming CS, Lin ZB, Zhang WJ, Wei L, Zhu XH, Jiang JP, Chen ZK (2004) The survival and value of liver transplantation for liver carcinoma: a single-center experience. Transplant Proc 36:2284–2286
Lencioni R, Cioni D, Crocetti L, Bartolozzi C (2004) Percutaneous ablation of hepatocellular carcinoma: state-of-the-art. Liver Transpl 10:S91–S97
Wong WS, Patel SC, Cruz FS, Gala KV, Turner AF (1998) Cryosurgery as a treatment for advanced stage hepatocellular carcinoma: results, complications, and alcohol ablation. Cancer 82:1268–1278
Zhou X, Tang Z, Yu Y (1996) Long-term results of multimodality treatment in patients with primary liver cancer. Zhonghua Wai Ke Za Zhi 34:518–521
Yin XY, Xie XY, Lu MD, Chen JW, Xu HX, Xu ZF, Liu GJ, Huang B (2004) Ultrasound-guided percutaneous composite thermal ablation technique in treatment of medium and large hepatocellular carcinoma. Zhonghua Wai Ke Za Zhi 42:1029–1032
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Chen, XP., Huang, ZY. Surgical treatment of hepatocellular carcinoma in China. Langenbecks Arch Surg 390, 259–265 (2005). https://doi.org/10.1007/s00423-005-0552-9
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DOI: https://doi.org/10.1007/s00423-005-0552-9