TREATMENT OF UNRESECTABLE PRIMARY LIVER-CANCER - WITH REFERENCE TO CYTOREDUCTION AND SEQUENTIAL RESECTION

Unquestionably, progress has been made in the early detection and earl y treatment of primary liver cancers (PLCs), although most remain unre sectable, mainly because the cancer is advanced and coexists with live r cirrhosis, particularly in Oriental patients. Thanks to the progress of regional cancer therapy, a multidisciplinary approach, and changin g concepts about surgical oncology, it has been proved that some unres ectable but not far advanced PLCs are potentially convertible to being resectable, particularly those cancers confined to the right lobe of a cirrhotic liver. A retrospective analysis of 571 unresectable PLCs r evealed the following: (1) There was an increase in 5-year survivals i n the series, from 0% during the 1960s (n = 61), to 4.8% during the 19 70s (n = 163), to 21.2% during the 1980s (n = 347). It might be a resu lt of the increase in double- or triple-modality treatments in these s eries (from 9.8%, to 19.6%, to 70.3%, respectively) and in the sequent ial resection rate after cytoreduction (from 0%, to 2.5%, to 14.7%). ( 2) The combination of hepatic artery ligation, hepatic artery cannulat ion and infusion, and intrahepatic arterial radioimmunotherapy has res ulted in better shrinkage of the tumor, a higher sequential resection rate, and a higher 5-year survival (28.2%). (3) Of the 55 patients who had initially unresectable PLCs and yielded ''cytoreduction and seque ntial resection,'' the 5-year survival was 58.5%. It is concluded that cytoreduction and sequential resection might be an important approach to improving the prognosis of patients with unresectable PLCs.