Resection of hepatocellular carcinoma: personal experience with 67 patients and long-term results.

ABSTRACT

Hepatocellular carcinoma (HCC) is the most common cancer in Thailand. Hepatic resection has been accepted as the only chance for cure. However; very limited information about the operative treatment and survival of HCC in Thailand has been documented. The author reviewed the experiences of surgical treatment of HCC at the National Cancer Institute, Bangkok and reports herein the long term outcome. From January 1986 to January 1996 a total of 884 primary liver cancers admitted in our institute were reviewed. 112 consecutive hepatic resections were performed by the author. 67 of 112 patients were HCC of which clinical features, survival rate and recurrence were studied. Liver cirrhosis was associated in 49 patients (73.1%). HBsAg was positive in 58 patients (86.6%). Preoperative AFP level was more than 400 ng/ml in 35 patients. The resectability for HCC was 11.0 per cent. In 50 of 67 hepatic resection, major hepatic resection were carried out. Postoperative major complications were found in 14 patients (20.9%). Postoperative mortality rate of 5 patients was 7.5 per cent. Survival curve was calculated by Kaplan-Meier with the overall survival rate at 1, 2, 3, 4, 5 years was 63.2 per cent, 28.6 per cent, 21.1 per cent, 14.5 per cent and 11.5 per cent respectively. 1, 3, 5 years survival rate for a tumor less than 5 cm was 91.0 per cent, 57.0 per cent, 49.4 per cent, tumor size of 5-10 cm was 57.5 per cent, 16.0 per cent, 9.0 per cent and tumor size more than 10 cm was 52.2 per cent, 0 per cent, 0 per cent. A significant difference in survival rate was observed by size. Postoperative recurrences were observed in 45 patients (67.2%) and 82.8 per cent of the patients had intrahepatic recurrence within 2 years. Hepatic resection is an appropriate treatment for a tumor less than 10 cm. However, a tumor larger than 10 cm should be considered for multimodality approaches. Intrahepatic recurrence is high and similar to the reports from the Orient. Close follow-up with prompt treatment for recurrence is the important factor to obtain better results.