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. 1998 Mar;227(3):433–439. doi: 10.1097/00000658-199803000-00016

Surgical intervention for patients with stage IV-A hepatocellular carcinoma without lymph node metastasis: proposal as a standard therapy.

I Ikai 1, Y Yamaoka 1, Y Yamamoto 1, N Ozaki 1, Y Sakai 1, S Satoh 1, N Shinkura 1, M Yamamoto 1
PMCID: PMC1191282  PMID: 9527067

Abstract

OBJECTIVE: The aim of this study was to evaluate the effects of surgical treatments for patients with stage IV-A hepatocellular carcinoma (HCC) without lymph node metastasis. SUMMARY BACKGROUND DATA: Nonsurgical therapy for highly advanced HCC patients has yielded poor long-term survival. Surgical intervention has been initiated in an effort to improve survival. METHODS: The outcome of 150 patients who underwent hepatic resection was studied. Survival analysis was made by stratifying stage IV-A HCC patients into two groups-those with and those without involvement of a major branch of the portal or hepatic veins. Those with involvement were further divided into subgroups according to major vascular invasions. RESULTS: Patients who had multiple tumors in more than one lobe without vascular invasion had a significantly better 5-year survival rate (20%) than those with vascular invasion (8%) (p < 0.01). The survival rate of patients with hepatic vein tumor thrombi (10%) was better than the rate for those with tumor thrombi in the inferior vena cava (0%), in whom no patients survived more than 2 years, although the survival rate for those with portal vein tumor thrombi in the first branch (11%) was no different from the rate for that in the portal trunk (4%). The operative mortality decreased from 14.3% in the first 6 years to 1.4% in the following 5 years. CONCLUSIONS: Surgical intervention for stage IV-A HCC patients brought longer survival rates for some patients. We recommend surgical intervention as an effective therapeutic modality for patients with advanced HCC.

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Selected References

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  1. Akashi Y., Koreeda C., Enomoto S., Uchiyama S., Mizuno T., Shiozaki Y., Sameshima Y., Inoue K. Prognosis of unresectable hepatocellular carcinoma: an evaluation based on multivariate analysis of 90 cases. Hepatology. 1991 Aug;14(2):262–268. [PubMed] [Google Scholar]
  2. Calvet X., Bruix J., Ginés P., Bru C., Solé M., Vilana R., Rodés J. Prognostic factors of hepatocellular carcinoma in the west: a multivariate analysis in 206 patients. Hepatology. 1990 Oct;12(4 Pt 1):753–760. doi: 10.1002/hep.1840120422. [DOI] [PubMed] [Google Scholar]
  3. Fan S. T., Lai E. C., Lo C. M., Ng I. O., Wong J. Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis. Arch Surg. 1995 Feb;130(2):198–203. doi: 10.1001/archsurg.1995.01430020088017. [DOI] [PubMed] [Google Scholar]
  4. HEALEY J. E., Jr, SCHROY P. C. Anatomy of the biliary ducts within the human liver; analysis of the prevailing pattern of branchings and the major variations of the biliary ducts. AMA Arch Surg. 1953 May;66(5):599–616. doi: 10.1001/archsurg.1953.01260030616008. [DOI] [PubMed] [Google Scholar]
  5. Iwatsuki S., Starzl T. E., Sheahan D. G., Yokoyama I., Demetris A. J., Todo S., Tzakis A. G., Van Thiel D. H., Carr B., Selby R. Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg. 1991 Sep;214(3):221–229. doi: 10.1097/00000658-199109000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Kiuchi T., Ozawa K., Yamamoto Y., Takayasu T., Maki A., Shimahara Y., Mori K., Kobayashi N., Yamaoka Y., Kumada K. Changes in arterial ketone body ratio in the phase immediately after hepatectomy. Prognostic implications. Arch Surg. 1990 May;125(5):655–659. doi: 10.1001/archsurg.1990.01410170103022. [DOI] [PubMed] [Google Scholar]
  7. Kumada K., Ozawa K., Okamoto R., Takayasu T., Yamaguchi M., Yamamoto Y., Higashiyama H., Morikawa S., Sasaki H., Shimahara Y. Hepatic resection for advanced hepatocellular carcinoma with removal of portal vein tumor thrombi. Surgery. 1990 Nov;108(5):821–827. [PubMed] [Google Scholar]
  8. Kumada K., Shimahara Y., Fukui K., Itoh K., Morikawa S., Ozawa K. Extended right hepatic lobectomy: combined resection of inferior vena cava and its reconstruction by EPTFE graft (Gore-Tex). Case report. Acta Chir Scand. 1988 Jul-Aug;154(7-8):481–483. [PubMed] [Google Scholar]
  9. Livraghi T., Giorgio A., Marin G., Salmi A., de Sio I., Bolondi L., Pompili M., Brunello F., Lazzaroni S., Torzilli G. Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology. 1995 Oct;197(1):101–108. doi: 10.1148/radiology.197.1.7568806. [DOI] [PubMed] [Google Scholar]
  10. Mazzaferro V., Regalia E., Doci R., Andreola S., Pulvirenti A., Bozzetti F., Montalto F., Ammatuna M., Morabito A., Gennari L. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996 Mar 14;334(11):693–699. doi: 10.1056/NEJM199603143341104. [DOI] [PubMed] [Google Scholar]
  11. Mori K., Ozawa K., Yamamoto Y., Maki A., Shimahara Y., Kobayashi N., Yamaoka Y., Kumada K. Response of hepatic mitochondrial redox state to oral glucose load. Redox tolerance test as a new predictor of surgical risk in hepatectomy. Ann Surg. 1990 Apr;211(4):438–446. doi: 10.1097/00000658-199004000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Nagasue N., Yukaya H., Ogawa Y., Sasaki Y., Chang Y. C., Niimi K. Clinical experience with 118 hepatic resections for hepatocellular carcinoma. Surgery. 1986 Jun;99(6):694–701. [PubMed] [Google Scholar]
  13. Okada S., Okazaki N., Nose H., Yoshimori M., Aoki K. Prognostic factors in patients with hepatocellular carcinoma receiving systemic chemotherapy. Hepatology. 1992 Jul;16(1):112–117. doi: 10.1002/hep.1840160119. [DOI] [PubMed] [Google Scholar]
  14. Ozawa K., Aoyama H., Yasuda K., Shimahara Y., Nakatani T., Tanaka J., Yamamoto M., Kamiyama Y., Tobe T. Metabolic abnormalities associated with postoperative organ failure. A redox theory. Arch Surg. 1983 Nov;118(11):1245–1251. doi: 10.1001/archsurg.1983.01390110003001. [DOI] [PubMed] [Google Scholar]
  15. Raoul J. L., Guyader D., Bretagne J. F., Duvauferrier R., Bourguet P., Bekhechi D., Deugnier Y. M., Gosselin M. Randomized controlled trial for hepatocellular carcinoma with portal vein thrombosis: intra-arterial iodine-131-iodized oil versus medical support. J Nucl Med. 1994 Nov;35(11):1782–1787. [PubMed] [Google Scholar]
  16. Ringe B., Pichlmayr R., Wittekind C., Tusch G. Surgical treatment of hepatocellular carcinoma: experience with liver resection and transplantation in 198 patients. World J Surg. 1991 Mar-Apr;15(2):270–285. doi: 10.1007/BF01659064. [DOI] [PubMed] [Google Scholar]
  17. Schwartz M. E., Sung M., Mor E., Fisher A., Popescu I., Fiel I., Sheiner P., Emre S., Guy S., Miller C. M. A multidisciplinary approach to hepatocellular carcinoma in patients with cirrhosis. J Am Coll Surg. 1995 May;180(5):596–603. [PubMed] [Google Scholar]
  18. Shimada M., Takenaka K., Kawahara N., Kajiyama K., Yamamoto K., Shirabe K., Nishizaki T., Yanaga K., Sugimachi K. Surgical treatment strategy for patients with stage IV hepatocellular carcinoma. Surgery. 1996 May;119(5):517–522. doi: 10.1016/s0039-6060(96)80260-1. [DOI] [PubMed] [Google Scholar]
  19. Sugihara S., Nakashima O., Kojiro M., Majima Y., Tanaka M., Tanikawa K. The morphologic transition in hepatocellular carcinoma. A comparison of the individual histologic features disclosed by ultrasound-guided fine-needle biopsy with those of autopsy. Cancer. 1992 Sep 15;70(6):1488–1492. doi: 10.1002/1097-0142(19920915)70:6<1488::aid-cncr2820700607>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  20. Takayasu K., Moriyama N., Muramatsu Y., Makuuchi M., Hasegawa H., Okazaki N., Hirohashi S. The diagnosis of small hepatocellular carcinomas: efficacy of various imaging procedures in 100 patients. AJR Am J Roentgenol. 1990 Jul;155(1):49–54. doi: 10.2214/ajr.155.1.1693808. [DOI] [PubMed] [Google Scholar]
  21. Takayasu K., Wakao F., Moriyama N., Muramatsu Y., Yamazaki S., Kosuge T., Takayama T., Okada S., Okazaki N., Makuuchi M. Postresection recurrence of hepatocellular carcinoma treated by arterial embolization: analysis of prognostic factors. Hepatology. 1992 Oct;16(4):906–911. doi: 10.1002/hep.1840160409. [DOI] [PubMed] [Google Scholar]
  22. Tsuda H., Hirohashi S., Shimosato Y., Terada M., Hasegawa H. Clonal origin of atypical adenomatous hyperplasia of the liver and clonal identity with hepatocellular carcinoma. Gastroenterology. 1988 Dec;95(6):1664–1666. doi: 10.1016/s0016-5085(88)80093-3. [DOI] [PubMed] [Google Scholar]
  23. Une Y., Misawa K., Shimamura T., Ogasawara K., Masuko Y., Sato N., Nakajima Y., Uchino J. Treatment of lymph node recurrence in patients with hepatocellular carcinoma. Surg Today. 1994;24(7):606–609. doi: 10.1007/BF01833724. [DOI] [PubMed] [Google Scholar]
  24. Vauthey J. N., Klimstra D., Franceschi D., Tao Y., Fortner J., Blumgart L., Brennan M. Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma. Am J Surg. 1995 Jan;169(1):28–35. doi: 10.1016/s0002-9610(99)80106-8. [DOI] [PubMed] [Google Scholar]
  25. Yamada R., Kishi K., Sato M., Sonomura T., Nishida N., Tanaka K., Shioyama Y., Terada M., Kimura M. Transcatheter arterial chemoembolization (TACE) in the treatment of unresectable liver cancer. World J Surg. 1995 Nov-Dec;19(6):795–800. doi: 10.1007/BF00299773. [DOI] [PubMed] [Google Scholar]
  26. Yamamoto M., Mogaki M., Matsuda M., Matsumoto Y. A possible prototype of multifocal recurrence after liver resection of hepatocellular carcinoma: report of a case. Surg Today. 1993;23(9):830–835. doi: 10.1007/BF00311629. [DOI] [PubMed] [Google Scholar]
  27. Yamaoka Y., Ozawa K., Kumada K., Shimahara Y., Tanaka K., Mori K., Takayasu T., Okamoto R., Kobayashi N., Konishi Y. Total vascular exclusion for hepatic resection in cirrhotic patients. Application of venovenous bypass. Arch Surg. 1992 Mar;127(3):276–280. doi: 10.1001/archsurg.1992.01420030038007. [DOI] [PubMed] [Google Scholar]
  28. Yamaoka Y., Ozawa K., Shimahara Y., Nakatani T., Mori K., Kobayashi N., Kumada K. A simple and direct approach to the portal triad structures for a left lobectomy or a left lateral segmentectomy. Surg Gynecol Obstet. 1988 Jan;166(1):78–80. [PubMed] [Google Scholar]
  29. Yamaoka Y., Ozawa K., Tanaka A., Mori K., Morimoto T., Shimahara Y., Zaima M., Tanaka K., Kumada K. New devices for harvesting a hepatic graft from a living donor. Transplantation. 1991 Jul;52(1):157–160. doi: 10.1097/00007890-199107000-00035. [DOI] [PubMed] [Google Scholar]
  30. Yasui M., Harada A., Torii A., Nakao A., Nonami T., Takagi H. Impaired liver function and long-term prognosis after hepatectomy for hepatocellular carcinoma. World J Surg. 1995 May-Jun;19(3):439–443. doi: 10.1007/BF00299186. [DOI] [PubMed] [Google Scholar]

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