CYTOREDUCTION AND SEQUENTIAL RESECTION FOR SURGICALLY VERIFIED UNRESECTABLE HEPATOCELLULAR-CARCINOMA - EVALUATION WITH ANALYSIS OF 72 PATIENTS

The poor prognosis of hepatocellular carcinoma (HCC) was partly a resu lt of the majority of unresectable HCCs in clinical patients. Fortunat ely, with the progress of regional cancer therapies and multimodality treatment, some of the localized unresectable HCCs were converted to r esectable ones. During the period 1960-1994, 72 of the 663 patients wi th surgically verified unresectable HCCs have been converted to resect able. Successful cytoreduction with median diameter reduced from 10 cm to 5 cm was mainly a result of the triple or double combination treat ment with hepatic artery ligation, hepatic artery cannulation with inf usion, radioimmunotherapy, and fractionated regional radiotherapy. The interval between the first operation and the sequential resection was 5 months. The operative mortality was 1.4%, for sequential resection, and the 5-year survival was 62.1%. Analysis of factors influencing se quential resection rate revealed HCCs that were single nodule, well en capsulated, situated at right Lobe or hepatic hilum, associated with m icronodular cirrhosis, and treated with triple or double combination m odalities had higher sequential resection rate as compared to their co unterparts. Analysis of factors influencing survival after sequential resection revealed that HCCs with a solitary tumor confined in one lob e, without tumor embolus, and without residual cancer in specimen of s equential resection, had longer survival. It is suggested that localiz ed unresectable, solitary, well encapsulated, right lobe or hilar HCC, associated with micronodular cirrhosis, will be good candidates for c ytoreduction and sequential resection; and HCCs with unilateral involv ement, without tumor embolus, and with complete necrosis of tumor afte r multimodality treatment favored better prognosis.