SUCCESSFUL TREATMENT OF EARLY HEPATOCELLULAR-CARCINOMA AND CONCOMITANT ESOPHAGEAL-VARICES

Twenty-two cirrhotic patients with hepatocellular carcinoma (HCC) and concomitant esophageal varices underwent aggressive hepatic resection accompanied by simultaneous devascularization, perioperative endoscopi c injection sclerotherapy, or both (group A). To evaluate this treatme nt, 37 cirrhotic patients without esophageal varices who underwent hep atic resection for small HCC (2 cm or less) during the same period (gr oup B) were studied to compare clinical data, preoperative laboratory data, pathologic findings, disease-free rates, and survival rates. The operative time, blood loss, and resected liver weight did not differ between the two groups; however, the tumor size of group A (2.7 +/- 1. 6 cm, mean +/- SD) was significantly larger than that of group B (1.5 +/- 0.3 cm). The preoperative liver function of group A was also more severe than that of group B except for prothrombin time. Despite these disadvantages, the 1-, 3-, and 5-year disease-free rates of the two g roups were 72% versus 94%, 48% versus 54%, and 38% versus 45%, respect ively, and the 1-, 3-, and 5-year survival rates were 91% versus 97%, 79% versus 79%, and 54% versus 67% (group A versus group B), respectiv ely, which showed no significant differences. Furthermore, there was n o variceal bleeding in group A after treatment. Based on the above fin dings, for treatment of HCC and concomitant esophageal varices, aggres sive hepatic resection accompanied by simultaneous devascularization, perioperative endoscopic injection sclerotherapy, or both is the prefe rred form of treatment.