CHANGES AND RESULTS OF SURGICAL STRATEGIES FOR HEPATOCELLULAR-CARCINOMA - RESULTS OF A 15-YEAR STUDY ON 452 CONSECUTIVE PATIENTS

In an attempt to define better surgical strategies for patients with h epatocellular carcinoma (HCC), we conducted a retrospective analysis o f 452 patients who underwent hepatic resection at our institute during a period of 15 years. The patients were divided into two groups: grou p A, comprising 188 patients who underwent hepatic resection before 19 88, and group B, comprising 264 patients after 1989. These groups were compared clinicopathologically. The percentage of patients with Child 's A disease but without cirrhosis, in group A was lower. The diameter of the resected tumor was larger in group A, and major hepatic resect ions and curative operations were more frequently performed in group A . In group B, there was less blood loss, the specimen weighed less, an d the hospital mortality was lower. Although the tumor-free survival r ates were similar between the two groups, the survival rate in group B was significantly better. While even minor hepatic resection accompan ied by a lower rate of surgical margin-free surgery has contributed to making hepatic resection safer, it has not improved the tumor-free su rvival rate. Conversely, recent advances in imaging modalities used du ring follow-up for the early detection of recurrence and for planning multimodality treatment have contributed to increasing the survival ra te.