Hepatocarcinoma: Considerations on surgical treatment in a personal seriesof 23 patients

BAGKGROUND/AIMS: Surgical treatment of primary liver tumors has undergone s ignificant changes in recent years because of improved surgical and anesthe siological techniques and better pre- and post-operative care. We review ou r personal series from 1987-1995. METHODOLOGY: Of 31 cases of hepatocellular carcinoma (HCC) observed in the years 1987-1995, 23 underwent curative resective surgery for a total of 24 liver resections: 6 hepatectomies; 10 segmentectomies; 4 atypical subsegmen tectomies; 2 extended resections, with excision of neoplastic thrombi withi n the portal vein; I orthotopic liver transplantation in another institutio n; and I limited segmental reresection for tumor recurrence. In 7 recent ca ses, pre-operative transcatheter arterial chemoembolization (TAE) was used. RESULTS: The mean survival of the 13 patients that are known to be deceased is 27 months (range: 7-114 months). Perioperative mortality was nil. Actua rial 5-year survival rate is 27%. Pre-operative TAE was used in 7 patients: 4 out of 7 lesions were significantly reduced at computed tomography (CT) scan control 21 days following TAE, while in 3 the tumor size was unchanged . CONCLUSIONS: Liver surgery, even major resections, has become safe with no perioperative mortality in our series. In our experience, pre-operative TAE has often produced significant reduction of the mass, but its real efficac y is still the subject of debate. TAE and percutaneous ethanol injection (P EI) should be evaluated as part of combined multimodality treatment in the therapy of large lesions previously considered inoperable.