The Availability of Positron Emission Tomography for Diagnosis of Thyroid Nodule / 대한내분비외과학회지

PURPOSE: Whole body Positron Emission Tomography (PET) was used to evaluate the existence of cancer cells. However, PET had limitations in identifying thyroid cancer cells because of their slow progression, and evidence regarding its accuracy in finding thyroid cancer cells is insufficient. Therefore, we investigated the usefulness of PET for evaluation of patients with thyroid nodules by studying the relationships between PET and thyroid ultrasonography. METHODS: We evaluated 4,627 patients who had undergone PET from January 2007 to October 2011 and selected 370 patients who had undergone thyroid ultrasonography. We compared and analyzed the amount of thyroid SUVmax of PET, the pattern of glucose uptake, and findings of thyroid ultrasonography based on their size, shape, location, and FNAC. RESULTS: Of 370 patients, 197 (53.2%) subjects were found to have thyroid nodules, and 211 (57.0%) subjects had higher sugar metabolism, regardless of having thyroid nodules. No statistical correlations were observed among nodule size, nodule location,and higher sugar metabolism, however, noticeable relationships were observed between the shape of the cells on thyroid ultrasonography and FDG uptake of PET. In cases of papillary thyroid cancer, there was higher FDG uptake, compared to benign lesions in particular, SUVmax of the papillary thyroid cancer showed a significantly elevated level of FDG uptake. CONCLUSION: Despite its limited usefulness in identifying the characteristics of thyroid nodules being benign or malignant, PET is appropriate for evaluation of the malignancy of thyroid cells

Eosinophilic Gastroenteritis Causing Gastro- intestinal Obstruction

Eosinophilic gastrointestinal disorder is uncommon and it has rarely been reported. The presence of increased numbers of eosinophils in the biopsy specimens of the gastrointestinal tract, the infiltration of eosionophils in intestinal crypts and gastric glands, the absence of involvement of other organs and the exclusion of other causes of eosinophilia support the diagnosis of eosinophilic gastroenteritis. This is characterized by infiltration of eosinophils in the gastrointestinal wall, and it's associated with protein-losing enteropathy, hypoalbuminemia, motility abnormalities and ascites. Although it is an idiopathic disorder, allergic and immunologic etiologies have been suggested. Steroid is the treatment of choice, but an operation is necessary in case of a surgical abdomen or if the patient is refractory to steroid therapy. Recently, authors experience 2 cases of eosinophilic gastroenteritis causing gastro-intestinal obstruction, and report here with clinical evaluation and literature review.

Incidental Adenomyoma of Stomach Associated with Early Gastric Cancer

An adenomyoma of the gastrointestinal tract is a rare, benign, tumor-like condition histologically characterized by glandular structures embedded within a smooth muscle stroma. An adenomyoma has been considered to be as an abortive variant of an ectopic pancreas. An ectopic pancreas is defined as the presence of pancreatic tissue that lacks anatomic and vascular continuity with the main body of the pancreas. Common sites of an ectopic pancreas are the stomach, duodenum, and upper jejunum. An adenomyoma may rarely undergo a malignant transformation or cystic dystrophy. Recently, the authors an experienced a case of an incidental adenomyoma of the stomach associated with early gastric carcinoma. We report that case here.

SMV Thrombosis on Taking Oral Contraceptive with Protein C and Protein S Deficiency

Mesenteric venous thrombosis (MVT) is uncommon, but it is often aggravated to a lethal form of intestinal ischemia. Multiple risk factors are associated with mesenteric venous thrombosis, including hypercoagulable or inflammatory states, previous abdominal surgery, abdominal trauma, portal hypertension and oral contraceptives. The use of estrogen-containing oral contraceptives accounts for 4% to 5% of all the cases of MVT. Oral contraceptives have been reported to decrease antithrombin III, increase the levels of prothrombin complex factor and factor VIII, and to inhibit the fibrinolytic system. We describe here a case of 42-year-old woman who had taken oral contraceptives for 7 years and she was diagnosed to have Protein C and Protein S deficiency, and superior mesenteric venous (SMV) and portal vein thrombosis. She underwent segmental resection of the small bowel. She was later discharged without suffering with short bowel syndrome or any other complications.

Terminal Ileal Burkitt's Lymphoma in an Adult

A Burkitt's lymphoma is a rare disease belonging to the aggressive non-Hodgkin's lymphomas, which usually occurs in children or adolescents. Burkitt's lymphoma was first reported in the medical literature as a jaw sarcoma of East African children, and those of the gastrointestinal tract occurring in adults have rarely been reported in Korea. Herein, we report an unusual case of a primary intestinal Burkitt's lymphoma, presenting with a palpable abdominal mass and abdominal pain, in a 46-year-old man. An ileocecectomy was performed, and the diagnosis confirmed by histological examination.

Carcinoid Tumor of the Stomach

A carcinoid tumor of the stomach is a neuroendocrine tumor originating from enterochromaffin cells in the submucosa of the stomach and has no specific clinical symptoms. They are uncommon, accounting for no more than 0.3% of all gastric tumors. However, this frequency has increased markedly due to endoscopic screening. Herein, the case of a 47-year-old man with a polypoid lesion (2 cm diameter) detected on endoscopic examination is reported. It was diagnosed as a carcinoid tumor before an operation. Although the tumor size was slightly larger than 2 cm in diameter, the lesion was treated by wedge resection as there was no lymph node involvement or other distant metastasis. The postoperative has course was uneventful. The patient has continued to do well for over 15 months of follow up.

Localized Peritonitis due to Perforation of Multiple Jejunal Diverticula

We report the case of a 77-year-old woman who presented with periumbilical pain from perforation of jejunal diverticula. The patient underwent surgery and multiple jejunal diverticula were found distributed from 30 cm to 60 cm distal to the ligament of Treitz. A segment of the jejunum containing all diverticula was resected and end-to-end anastomosis was performed. The postoperative course was uneventful. The patient continued to do well at last follow-up, 26 months after operation. Diverticulum of the jejunum is uncommon and the majority of patients are asymptomatic. Symptoms indicating diverticulum are few and often nonspecific; they may present either as generalized abdominal pain associated with intestinal disturbances or in more serious case, they can lead to complications requiring emergency surgery. In light of these considerations, we thought it useful to report a case of complicated multiple jejunal diverticula and draw attention to its complications that can be a source of gastrointestinal symptoms.

Isolation and Culture of Pig Hepatocyte in Large Scale for the Application of Bioartificial Liver System / 대한간학회지

BACKGROUND/AIMS: Acute hepatic failure is a serious problem. Its mortality reaches up to 80%. Only liver transplantation has been accepted as a definite treatment for patients with hepatic failure but shortage of donor organs is the main obstacle of this approach. A possible solution to this problem is a bioartificial liver system, perfusion of patients blood to isolated hepatocyte. In this study, we performed the isolation and culture of pig hepatocyte in large scale for the application of bioartificial liver system. METHODS: Hepatocyte isolation was performed by two-step collagenase method via portal vein perfusion in 10kg female pigs. After that, we compared the functional differences of the spheroid culture to the monolayer culture of hepatocyte. The viability and the function of hepatocyte were assessed using trypan-blue exclusion test and the measurement of the rate of ureagenesis and ammonia removal. RESULTS: The average viability and yield of hepatocyte were 86.8 +/- 8.0 % and 7.8 +/- 5.4 X 10(9), respectively. The spheroid culture was superior to the monolayer culture in functional aspect of hepatocyte, and their differences, especially for ammonia removal, were more apparent in parallel with culture time. CONCLUSIONS: For hepatocyte isolation, we obtained sufficient viability and yield of hepatocyte for clinical usage of bioartificial liver system. The function of hepatocyte seems to be better in the spheroid culture than in the monolayer culture. Further studies are needed for application of bioartificial liver system in clinical setting.

Hepatocytes isolation from UW preserved rat liver / 한국간담췌외과학회지

BACKGROUND/AIMS: In the immunological and functional aspects, freshly isolated human hepatocytes are better than animal hepatocytes from other species such as the pig and hepatocytes from human tumor cell lines. Human liver tissue for hepatocyte isolation can be obtained either from surgical specimens of patients with liver disease, such as hepatocellular carcinoma or from donor livers that are not suitable for transplantation. In the latter case, the liver may be preserved in 4 degrees C UW solution. Therefore, studies of the limit on the preservation time to get clinically applicable hepatocytes, and proper isolation techniques improving cell viability are needed. In this study, the authors isolated hepatocytes from a few kinds of the liver with different UW preservation times and different isolation techniques. METHODS: Male Sprague-Dawley rats weighing 200g-250g were used. The hepatocytes were isolated from unpreserved livers(control), livers preserved for 24 hours in UW solution, and livers preserved for 48 hour in UW solution, with a modified Seglen's two step method. To improve cell viability, 5mM glycin was added to the EDTA solution in one group and in another, the pH of the EDTA solution was slowly changed from 6.5 to 7.25. RESULTS: The control group showed 80.0% of cell viability. 53.8% of isolated hepatocytes were viable even after 24 hours of preservation. The cell viability decreased to 36.1% and severe cellular damage was observed after 48 hours preservation. The glycin and pH change showed no protective effect on the isolation of hepatocytes from UW preserved livers. CONCLUSION: After 24 hours preservation in UW solution, many clinically useful hepatocytes were isolated with a modified Seglen's two step method. Further studies concerning the preservation of functions of hepatocytes isolated from UW preserved livers and on the technique of cell culture and cryopreservation are needed.

Expression of vascular endothelial growth factor (VEGF) in hepatocellular carcinoma / 한국간담췌외과학회지

BACKGROUND/AIMS: Vascular endothelial growth factor (VEGF) is one of the most potent angiogentic factors in several tumors including hepatocellular carcinoma (HCC). This study was planned to evaluate the correlation between the expression patterns of VEGF and the clinicopathologic features of patients with HCC. METHODS: Twenty-seven patients with curatively resected HCCs were included in this study. To determine the expression patterns of VEGF, western blotting and immunohistochemical staining were performed using polyclonal rabbit VEGF IgG (Santa Cruz, CA) as a primary antibody. These results were compared and analyzed to clinicopathologic features of patients. RESULTS: In Western blotting, Only 5 cases exhibited higher VEGF expression (T/N > or = 0.8) in tumorous region, which was well correlated to the immunohistochemical staining. Between higher and lower VEGF expression group, there were no significant differences in the hypervascularities on angiography or microangiogenic invasions on histologic finding. Other clinicopathologic factors had no significances on VEGF expression. Two year disease-free suvival rate in higher VEGF expression group was 20.0%, which was significantly lower than 73.7% in lower VEGF expression group (p=0.02). But, in two year overall suvival rate, there were no differences between two groups (80.0% vs 82.8%; p=0.80). CONCLUSION: In this study, higher VEGF expression seems to be correlated with higher recurrence rate of HCC. Wide-based prospective study is needed to confirm the potentiality of VEGF expression as a prognostic factor of HCC.

Allogenic split liver transplantation in pigs / 한국간담췌외과학회지

BACKGROUND/AIMS: The shortage of cadaveric liver donor is particularly critical for children. Split liver transplantation, not only overcomes the drawbacks of reduced size grafts and living donor transplantation for children but also increases the total number of donor organs. The purpose of this study is to examine the technical feasibility of split liver transplantation in pig. METHODS: Nine pigs(3 donors and 6 recipients weighing 19-33Kg) were used. In donor pigs, the liver was divided between right medial lobe and left medial lobe without inflow occlusion under general anesthesia. Left liver was harvested first and then right liver was harvested as usual manner. One recipient pig underwent left lobectomy and left graft were transplanted orthotopically (auxiliary partial orthotopic liver transplantation(APOLT)). For right graft, conventional orthotopic liver transplantation were done. Veno-venous bypass was not performed. Instead, superior and inferior mesenteric arteries were clamped temporarily. RESULT: There was no anhepatic time when using left graft. Cold ischemic time were 2hr 35min, 1hr 21min, and 1hr 5min, respectively. When using right graft, anhepatic time was 72min, 54min, and 49min, respectively. Cold ischemic time was 5hr 17min, 6hr 32min, and 4hr 18min, respectively. Biochemical laboratory data(WBC, hemoglobin, platelet, ALT/AST, LDH, prothrombin time) after reperfusion 1 hour showed good graft function in all transplant pigs and were better in the recipient pigs taking left graft than right graft. Histologic findings at 4 hours after reperfusion show normal appearance except mild ischemic change around central vein. All transplant pigs survived over 24 hours without any major complication. CONCLUSION: APOLT for left graft and conventional liver transplantation for right graft without venovenous bypass were successful in pig. In situ split liver transplantation in pig is technically feasible procedure and this model is suitable for future studies of split liver transplantation.

The effect of intraoperative transfusion on the prognosis in hepatectomized hepatocellular carcinoma patients / 한국간담췌외과학회지

BACKGROUND/AIMS: There are many reports in which perioperative transfusion was closely related to the survival of cancer. The long-term survival rate of patients with hepatocellular carcinoma undergoing hepatectomy has improved, and it may be related to the reduction of intraoperative transfusion. The aim of this study is to evaluate the effect of intraoperative transfusion on the prognosis in the hepatectomized hepatocellular carcinoma patients and the relationship between the survival improvement and reduction of intraoperative transfusion. METHODS: From 1988 Jan. to 1995 Dec., 507 cases in which the amount of intraoperative transfusion was known were reviewed. Operative transfusion of whole blood or packed red cells was included in this study. The clinical, operative, and pathological factors were analyzed to identify factors that affected long-term survival and disease free survival. RESULTS: By multivariate analysis, Child classification, the extent of resection, portal vein invasion, and blood transfusion(more than 7 units) were shown to be independent factors in overall survival. Child classification, the number of tumors, portal vein invasion, and blood transfusion(more than 7 units) were shown to be independent factors in disease free survival. CONCLUSION: Operative blood transfusion affects the long-term survival and the disease free survival. Therefore, the intraoperative transfusion should be reduced if possible. Through the improvement of surgical technique and instrument, surgeon can reduce the intraoperative bleeding, and this reduction of intraoperative bleeding may contribute the improvement of survival through the reduction of intraoperative transfusion.

Effectiveness of Diagnogstic Tools for The Detection of Recurrence after Curative Resection of Hepatocellular Carcinoma / 한국간담췌외과학회지

BACKGROUND/AIMS: In spite of improved diagnostic and therapeutic methods, the prognosis of hepatocarcinoma( HCC) is still poor because of the high recurrence rate. Early detection and active treatment of recurrent HCC are important to improve the survival. The objective of this study is to compare the effectiveness of diagnostic tools for early detection of the recurrence of HCC. METHODS: We retrospectively studied 236 patients who underwent curative hepatic resection for HCC at SNUH between 1993 and 1995. Postoperatively, we checked radiologic studies every three months and serum alpha- fetoprotein level monthly first, then every three months to detect recurrence. The patients were divided into four group (Low-Low;L-L, Low-High;L-H, High-Low;H-L, High-High;H-H) according to the serum levels of pre- and post-operative(3 months) alpha-fetoprotein levels (Low ; 20ng/ml). RESULTS: Overall recurrence rate was 55.1%. The recurrence rates in L-L gr., L-H gr, H-L gr., and H-H gr were 40.7%, 75.0%, 42.9% and 91.8% respectively. Increasing levels of alpha-fetoprotein at the time of dectection of recurrence were found in 13.6%, 66.7%, 25.9% and 92.9%, respectively(p<0.05). The 3- year disease-free survival rates are 62.1%, 25.0%, 57.8% and 6.3%, respectively(p<0.05). The 3-year overall survival rates are 79.2%, 50.0%, 83.6% and 51.1%, respectively(p<0.05). The detection rates of ultrasonography(US) and computed tomograpy(CT) were 82.4% and 97.2% respectively. Seven patients had lung metastasis on chest X-ray and two bone metastasis on bone scan, two spinal metastasis on spine X-ray and MRI and 2 adrenal metastasis by US and CT were detected. CONCLUSION: The patients who have high serum levels of alpha-fetoprotein postoperatively have a tendency to recur early. On the other hand, patients who have low serum levels of alpha-fetoprotein postoperatively recur late, usually without its elevation. Therefore, in former cases, early recurrence or remnant tumor should be suspected and in latter cases, regular US and/or CT is a more useful method for early detection of recurrent HCC than frequent checking of serum alpha-fetoprotein.

Clinical Significance of Preoperative Transcatheter Arterial Embolization in Hepatocellular Carcinoma

PURPOSE: Transcatheter arterial embolization (TAE) is widely used as a diagnostic and therapeutic tool for hepatocellular carcinomas (HCC). Although there are many controversies about the effect of preoperative TAE, in some centers, it has been done in most patients with HCC. We investigated the effect of preoperative TAE on the prognosis for the patients who had undergone curative hepatic resection for HCC. METHODS: We retrospectively studied 541 patients who had undergone curative hepatic resection for HCC at the Department of Surgery in Seoul National University Hospital between 1988 and 1995. Among those, preoperative TAE was done in 489 patients (TAE (+) group) and was not done in 52 patients (TAE (-) group). We examined demographics, tumor-free survival rate, overall survival rate, and complications. RESULTS: There were no statistical differences of demographic data between TAE (+) and TAE (-) groups. The 1-year, 3-year and 5-year tumor-free survival rates for TAE (+)/TAE (-) groups were 72.9%/70.6%, 43.8%/36.7% and 35.7%/30.5%, respectively. There was no statistical difference. The 1-year, 3-year and 5-year overall survival rates for TAE (+)/TAE (-) group were 85.5%/86.0%, 69.1%/63.3% and 56.6%/51.7%, respectively. These differences were not statistically significant (p>0.05). The postoperative complication rates were 26.6% for patients undergoing pre operative TAE and 26.9% for patients not undergoing it; these differences were not statistically significant (p>0.05). In the patients who had preoperative TAE, the hospital stay was prolonged (24.4+/-11.4 days vs. 17.8+/-8.8 days) and cost increased significantly (about 1,300,000 won). CONCLUSION: Preoperative TAE shows no advantages in the treatment of resectable HCC. Rather, it prolongs hospital stay and increases cost. Therefore, preoperative TAE should be done only in selected patients.

Culture-Sensitivity Test and Infectious Complication in Perforated Appendicitis

PURPOSE: The purpose of this study was aimed to disclose main affected organisms in patients with perforated appendicitis and to analyze correlations between culture-sensitivity test and infectious complication. METHODS: In 26 of 421 patients who had undergone appendectomy due to acute appendicitis from April 1996 to March 1999, we performed culture-sensitivity test. The clinical records of these patients were collected and reviewed about clinicopathological features and results of culture-sensitivity test, retrospectively. Culture material was collected in BBL transport media with cotton swab and cultured by MacConkey agar plate. The method of MIC by VITEK was used for sensitivity test. RESULTS: Cultured organisms were E. coli (18 cases), Pseudomonas (4), Enterobacter (2), Enterococcus (1), and Proteus (1). In sensitivity test, sensitive antibiotics against all cultured organism were amikacin, ceftriaxone, imipenem and cefotetan. But ampicillin, sulfametoxazole/trimethoprim and piperacillin were mostly resistant. Infectious complications occurred in 11 of 26 patients (42.3%) and consisted of 9 wound infection and 2 intraabdominal abscess. Especially, 13 of 18 cases in which E. coli were isolated, were resistant to ampicillin. And they had infectious complications statistically more than those who were not resistant to ampicillin (p=0.036). CONCLUSIONS: E. coli was a main organism in perforated appendicitis. In case of ampicillin-resistant E. coli, the patients were susceptible to infectious complication such as wound infection and intraabdominal abscess.

Risk Factors of Early Recurrenec after Curative Hepatic Resection for Hepatocellular Carcinoma / 대한암학회지

PURPOSE: The purpose of this study was to clarify the risk factors of early recurrence within 1 year by comparing them with patients without recurrence within 3 years after curative liver resection in hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Three hundred and twenty six patients with HCC who underwent curative liver resection between 1991 Jan, to 1995 June were observed for possible recurrence for least 3 years. These patients were divided into two groups: 79 patients who had recurrence within 1 years (early recurred group) and 132 patients who had no recurrence within 3 years (no recurred group). RESULTS: Overall survival rates in 5 years after 1iver resection were 17.5% in early recurred group and 94.9% in no recuned group. Risk factors of early recurrence in multivariate analysis were the presence of liver cirrhosis in nontumorous parenchyme (p=0.011, relative risk (RR)=2.5), tumor size (p=0.004, RR 2.9), multiple mass (p 0.015, RR=3.4), the presence of angioinvasion (p=0.043, RR=3.7), serum alpha-fetoprotein more than 20 ng/dl (p=0.007, RR=2.7), major liver resection more than lobectomy (p=0.039, RR=3.2). However, other factors such as age, sex, preoperative transcatheter arterial embolization (TAE), several liver function tests, Child classification, reseetion margin, total necrosis of tumor after preoperative TAE, tumor encapsulation, histologic type, Edmondsons grade, were not significant in our study. CONCLUSION: The risk factors of early recurrence were liver cirrhosis, tumor size, number of tumor, angioinvasion, serum alpha-fetoprotein, and major liver resection. Biologic characteristics of tumor were the most important risk factors of early recurrence. Because the extent of liver resection is the only risk factor that depends on surgeons decision, we must consider this factor in liver resection for HCC.

Analysis of Clinical Features and Risk Factors of Postoperative Pneumonia

BACKGROUND: Although pneumonia is the third most common type of nosocomial infection following urinary tract infection and surgical wound infection, it is associated with the highest mortality rate (28-37%), and 16% of deaths in hospitals are caused by it. The purpose of this study was to analyze our cases of postoperative pneumonia and to establish the principles of prevention and treatment for postoperative pneumonia. METHODS: Thirteen cases diagnosed as postoperative pneumonia out of 11,227 patients who were operated on from Jan. 1994 to June 1997 at the Department of Surgery, Seoul National University Hospital, were analyzed by a retrospective review of their medical records. The diagnosis of postoperative pneumonia was based on the `Center for Disease Control' criteria. RESULTS: The incidence of postoperative pneumonia was 0.12%. The median patient age was 58 years (ranging from 31 to 70 years). There were 7 males and 6 females. The causal diseases for the operations were 7 gastric cancers, 2 ileus, and 4 others. Five subtotal gastrectomies, 3 total gastrectomies, and 5 other operations were performed, and there were 10 elective and 3 emergent operations. The preoperative status was investigated. Two cases were preoperatively diagnosed as bronchiectasis. Other associated medical illnesses were 2 coronary arterial diseases, 2 hypertensions, and 2 others. Six patients had a history of smoking. The `American Society of Anesthesiologist' physical status score was checked in 11 cases. There were 2 cases with one points, six cases with two points, and 3 cases with a higher number of points. The average time until diagnosis after operation was 4.0 +/- 3.85 days. All had purulent sputum and high fever, and showed pneumonic infiltration on Chest PA. Four Gram positive and 7 Gram negative bacteria were isolated from the sputum of 12 patient, including three cases with Pseudomonas aeruginosa and two cases with MRSA. All patients were treated with antibiotics. Five patients were admitted to the ICU, and 3 patients maintained intubation after anesthesia. Twelve patients had a nasogastric tube, for which the average period of intubation was 14.1 +/- 14.61 days. One patient expired, and 12 improved. CONCLUSIONS: There was a very low incidence of postoperative pneumonia, and most patients were old. Upper abdominal surgery proved to be an important risk factor, and prolonged maintenance of the nasogastric tube may predispose postoperative patients to pneumonia. The appearance of many antibiotics- resistant bacteria demanded the judicious use of antibiotics.

PROGNOSTIC FACTORS OF HEPATOCELLULAR CARCINOMA AFTER CURATIVE HEPATIC RESECTION / 한국간담췌외과학회지

To further define the prognostic factors associated with long term survival of hepatocellular carcinoma, we retrospectively studied 371 patients with pathologically diagnosed hepatocellular carcinoma who underwent curative hepatic resection between 1991 and 1995. We included the 16 patients who underwent noncurative hepatic resection in calculating overall survival. The male to female ratio was 5.1 to 1 and their average age was 52.5 years. About 20 variables were subject to univariate and multivariate analysis and their survivals were calculated using the Kaplan-Meier method. 55.6% of (220 of 396) patients had liver cirrhosis and 73.2% of (290 of 396) patients were positive in HBsAg. Operative mortality and inhospital death rate were 1.5% and 0.8%, each and postoperative morbidity rate was 22.5%. The cumulative 1, 3 and 5 year survival rates including noncurative resected cases were 85.9%, 67.2% and 54.8%, respectively. The cumulative 1, 3 and 5 year survival rates of 371 curative resected cases were 87.3%, 68.7% and 56.4%, respectively. Disease free 1, 3, 5 year survival rates of 371 curative resected cases were 74.8%, 48.2% and 40.8%, respectively. The factors such as alpha- fetoprotein, Child's classification, prothrombin time, extent of liver resection, and number of tumor were statistically significant factors associated with cumulative survival.(p<0.05) And alpha-fetoprotein, total necrosis after TACE, viral hepatitis, and invasion of portal vein were significant factors associated with cumulative disease free survival. Only alpha-fetoprotein was associated significantly with cumulative survival and cumulative disease free survival. Length to the resection margin was not significantly associated with survival.