PROGRESS AND PROSPECTS IN HEPATOCELLULAR-CARCINOMA SURGERY

Hepatocellular carcinoma (HCC), the second cause of cancer death in Ch ina, is responsible for 130,000 deaths every year. However, as a resul t of efforts in early detection and small HCC resection, re-resection for subclinical recurrence, cytoreduction and second-stage resection f or unresectable HCC, and aggressive palliative surgery other than rese ction (hepatic artery ligation/cannulation, cryosurgery, etc.), an enc ouraging improvement of long-term survival of inpatients has been obse rved in the authors' institution. In the entire series of 2672 HCC inp atients, the 5-year survival was 1.8 % in 1958-70, 12.2 % in 1971-83, and 46.7 % in 1984-95. The 5-year survival rates were : 61.3 % for sma ll HCC resection (n = 645), 33.6 % for large HCC resection (n = 950), 48.9 % for re-resection (n = 147) calculated from the first resection; 67.9 % for second-stage resection (n = 73), and 19.8 % for palliative surgery (n = 574, including 73 with second-stage resection). By 1995, 239 HCC patients survived for more than 5 years. Recurrence and metas tasis remained the major obstacles to more prolonged survival after HC C surgery. Molecular studies of HCC invasiveness, experimental interve ntion in the newly established highly metastatic model of human HCC in nude mice in the authors' institution have also been delineated. It i s concluded that early detection and small HCC resection remain the ma jor approach to improve survival. Aggressive surgical treatment, such as re-resection and second-stage resection, are also important, and in vasiveness-related recurrence will be the next target to be studied.