[Clinical investigation of hepatectomies for hepatocellular carcinoma--significance of extended hepatectomy for advanced hepatocellular carcinoma]

Although the diagnostic methods for hepatocellular carcinoma (HCC) are now being improved, there are still many cases detected at advanced stage. We, based on the Redox theory and using a technique of vascular surgery and liver transplantation, made it possible to perform the extended hepatectomy more actively even in the advanced cases which were previously considered to be in-operable. We report these extended hepatectomies in this paper. From January 1985 to August 1989, we performed 263 hepatectomies for HCC. Out of these 263 cases, we examined 208 cases which had an interval more than three months from the time of the operation and had exact follow-up data at the end of August 1989. There are 57 extended hepatectomies and they consist of 4 groups as follows. 1) Multiple group (14 cases): the operation for the cases with multiple daughter nodules in both lobes besides the main tumor. 2) Thrombus group (30 cases): the operation for the cases with portal tumor thrombus in the first branch or the main trunk of portal vein. 3) IVC group (4 cases): the operation adding resection and reconstruction of IVC because tumor was hardly fixed to the wall of IVC. 4) Recurrence group (9 cases): the operation for hepatic recurrence. Six cases of the Multiple group survived more than one year and one case is still alive more than two years after surgery. The 6-months, 1-year and 2-year cumulative survival rates of the Multiple group are 50.5%, 38.3%, and 8.5% respectively and these results are better than other reports. Forty-three hepatic recurrences were observed in 138 cases whose tumor was completely resected macroscopically.(ABSTRACT TRUNCATED AT 250 WORDS)