Effect of RFA combined with TACE for treatment of early hepatocellular carcinoma with liver cirrhosis / 局解手术学杂志

Objective To assess the effect of radiofrequency ablation ( RFA) combined with transcatheter hepatic arterial chemoemboli-zation ( TACE) and radiofrequency ablation alone for the treatment of early hepatocellular carcinoma ( HCC) with liver cirrhosis. Methods The data of all the patients that were given RFA+TACE (n=51) and RFA (n=53) treatments in our hospital from January 2008 to De-cember 2013 were analyzed. The demographic data,process of operation,postoperative complications,postoperative recovery and follow-up of the patients in two groups were carefully compared. Results The average follow-up time was (37. 6 ± 20. 7)months,38 cases were dead and 76 cases were survival. The overall survival rates of 1 years,3 years,5 years after operation were respectively 96. 5%,78. 7%,65. 9% in RFA+TACE group and 94. 3%,75. 6%,62. 3% in RFA group. Tumor-free survival rates of 1 years,3 years,5 years were 75. 4%,47. 3%, 32. 6% in RFA+TACE group,and 63. 1%,37. 2%,22. 4% in RFA group. Conclusion For patients with early hepatocellular carcinoma with liver cirrhosis,RFA combined with TACE have higher tumor free survival rate than RFA alone in the treatment of early hepatocellular carcinoma,but no difference in overall survival rate. The results still need to be validated by prospectively randomized controlled trials.

Tratamiento quirúrgico / Surgical treatment

El tratamiento quirúrgico ha sido tradicionalmente el primer tratamiento en mente cuando se enfrenta a un paciente con CHC; sin embargo, el advenimiento de nuevas técnicas no quirúrgicas ha replanteado su uso, y en la actualidad el éxito en el tratamiento depende básicamente de una adecuada selección del paciente para este tipo de terapia. El tratamiento quirúrgico del CHC varía cuando se trata de un tumor en un paciente con hígado cirrótico y no cirrótico, y esto debe tenerse en cuenta al momento de decidir el tipo de tratamiento.

Although surgical treatment has traditionally been the first treatment considered for patients with HCC, the advent of new non-surgical techniques has led to a rethinking of its use. Today, successful surgery basically depends on proper selection of the patient. Surgical treatment of HCC varies for tumors in patients with non-cirrhotic and cirrhotic livers which must be taken into account when deciding on the type of treatment.

Outcome of the Liver Resection of the Hepatocellular Carcinoma under Milan Criteria

PURPOSE: Liver resection (LR) has been the treatment of choice for hepatocellular carcinoma (HCC), but resection and survival rates remain low, and recurrence is common in cirrhotic patients. This study was designed to evaluate the outcome after resection of potentially transplantable early HCCs and compare it with that for liver transplantation (LT) as reported in the literature. METHODS: We studied 109 patients with HCC under the Milan criteria who underwent LR at Kyungpook National University Hospital from September 1997 to May 2002. The patients were divided into two groups: group A had a single tumor and group B had two or three tumors. RESULTS: The mean age was 56.1+/-8.1 years and the male-to-female ratio was 4.7: 1. Most of the patients had chronic liver disease due to viral hepatitis, but had preserved hepatic function. Overall survival rates (SR) at 1, 2, 3, and 4 years were 86.7, 69.4, 44.8, and 13.3%, respectively, and the corresponding disease-free survival rates (DFSR) were 74.2, 53.8, 41.6, and 23.7%. SR and DFSR were not significantly different between the two groups, although group B tended to have lower SR and DFSR. At a median follow-up of 25.3 months, 52 patients experienced recurrence, most of whom had intrahepatic recurrence within 2 years after resection. At the time of the diagnosis of recurrence, 34 patients were considered eligible for LT. CONCLUSION: Although most of the patients had preserved hepatic function, LR of early HCC showed low survival rates and high recurrence rates compared with those after LT reported in the literature and in our experiences. Therefore, in the absence of limiting factors, LT may be the better option for surgical treatment of patients with early HCC, even when preserved hepatic function is maintained.