EVOLUTION OF SURGERY IN THE TREATMENT OF HEPATOCELLULAR-CARCINOMA FROM THE 1950S TO THE 1990S

In the 1950s, hepatic lobectomy for huge hepatocellular carcinoma (HCC ) has benefited 5-10% of HCC patients; in the 1970s, limited resection for small HCC and reresection for recurrence have benefited another 5 -10% HCC patients. Cytoreduction and sequential resection for unresect able HCC might be of benefit to a further 5-10% HCC patients in the 19 90s. Analysis of 1,642 patients with pathologically proven HCC in 1959 -1991 demonstrated that the series 5-year survival has increased from 3.0% (n = 136) in the 1960s, to 12.2% (n = 440) in the 1970s, to 40.2% (n = 1,066) in the 1980s, which was correlated to the increasing numb er of limited resections for small HCC, reresections for subclinical r ecurrence, and cytoreductions and sequential resections for portions o f unresectable HCC. With the advances in early detection, multimodalit y treatment, and changing concepts in surgical oncology, the role of s urgery in the treatment of HCC has increased. (C) 1993 Wiley-Liss, Inc .