SURGICAL-MANAGEMENT OF LARGE HEPATOCELLULAR CARCINOMAS - CRITERIA FORCURATIVE HEPATECTOMY

This study was designed to determine the criteria for curative resecti on in hepatectomy for large hepatocellular carcinoma. The extent of re section was closely related to recurrence rate, and complete removal o f the involved segments was found to be essential for curative hepatec tomy. Patients with satellite nodules had a high incidence of recurren ce; in fact, carcinoma recurred in all patients, with satellite nodule s scattered through more than one segment, despite whole tumor removal . However, curative resection could be achieved in patients with porta l involvement confined to the second portal branches, when the tumor, including tumor thrombi, was removed en bloc. On the basis of these re sults, we define complete en bloc removal of the involved segments, in cluding portal involvements, as curative resection, even though curati ve hepatectomy is not attainable in patients with satellite nodules in more than one segment and/or tumor thrombi in the first branches or t runcus of the portal vein.