Extension of surgical indication for advanced hepatocellular carcinoma : Is it possible to prolong life span or improve quality of life ?
We have tried to break through the limitations of treatment for advanced hepatocellular carcinoma (HCC), which has been regarded as a contraindication for surgical treatment.
Materials and Methods
In 640 cases of hepatic resection for Liver cancer, we analyzed 55 cases of HCC with tumor thrombi in the trunk or first branch of the portal vein (PV) which required additional PV thrombectomy, 5 cases with direct invasion or compression to the inferior vena cava (IVC) which required replacement of IVC with a polytetrafluoroethylene (PTFE) tube, 9 cases with involvement of the extrahepatic bile duct (BD) which required additional extirpation of tumor fragments in the BD, 6 cases with tumor thrombi in the IVC which required IVC thrombectomy, and 4 cases of huge main tumor with intrahepatic metastasis in the entire liver which required intraoperative ethanol injection.
Mean survival times in these groups were 796,717,650,220, and 147 days, respectively.
All patients with IVC thrombi and large tumor with intrahepatic metastasis in the entire liver died of early recurrence in spite of surgical treatment.
By contrast, half of the patients with PV thrombi, BD involvement and IVC invasion or compression survived approximately 500 days because of a combination of hepatic resection, additional intraoperative treatment and postoperative treatment, and some patients could enjoy a longer life. (...)
Mots-clés Pascal : Carcinome hépatocellulaire, Stade avancé, Traitement, Résection chirurgicale, Indication, Amélioration, Qualité vie, Critère décision, Survie, Résultat, Homme, Appareil digestif pathologie, Foie pathologie, Tumeur maligne, Chirurgie
Mots-clés Pascal anglais : Liver cell carcinoma, Advanced stage, Treatment, Surgical resection, Indication, Improvement, Quality of life, Decision criterion, Survival, Result, Human, Digestive diseases, Hepatic disease, Malignant tumor, Surgery
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0492597
Code Inist : 002B25G03. Création : 10/04/1997.