Skip to main content
Erschienen in: Journal of Cancer Research and Clinical Oncology 6/2004

01.06.2004 | Original Paper

Volume reduction surgery for advanced hepatocellular carcinoma

verfasst von: Kazuto Inoue, Takayuki Nakamura, Taira Kinoshita, Masaru Konishi, Toshio Nakagohri, Tatsuya Oda, Shinichiro Takahashi, Naoto Gotohda, Takayuki Hayashi, Shigeru Nawano

Erschienen in: Journal of Cancer Research and Clinical Oncology | Ausgabe 6/2004

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The aim of this study was to evaluate the prognostic impact of reductive surgery on the survival of patients with advanced hepatocellular carcinoma (HCC).

Methods

Eligible patients had a main tumor greater than 10 cm in diameter with multiple intrahepatic metastases (>5 nodules), and good liver function (Child-Pugh class A), but no tumor thrombus in the main portal vein. The main tumor was surgically removed but the metastases were not removed and were treated with repeated transcatheter hepatic arterial chemo-embolization (TAE).

Results

From Jun 1997 to May 2003, 13 patients (median age 61 years, range: 48–74) were prospectively enrolled. The median diameter of the main tumor was 14 cm (range 11.5–18.0). No major surgical complications were observed and the median hospital stay was 12 days (range 7–20). The first TAE was performed 1 month after hepatectomy in all patients and was repeated for median of 5 (range: 1 to 16) times. Complete remission was observed in two patients. One patient had recurrence afterwards but another patient survived 41 months without recurrence. Three patients survived more than 3 years. The overall 1-, 3-, and 4-year survival rates of the 13 patients were 67.7%, 40.6%, and 40.6%, respectively.

Conclusions

Volume reduction surgery followed by TAE might prolong the survival of patients with a large HCC and intrahepatic metastases, especially those with a main tumor on the right side.
Literatur
Zurück zum Zitat Arii S, Okamoto E, Imamura M, The Liver Cancer Study Group of Japan (1996) Registries in Japan: current status of hepatocellular carcinoma in Japan. Liver Cancer Study Group of Japan. Semin Surg Oncol 12:204–211CrossRefPubMed Arii S, Okamoto E, Imamura M, The Liver Cancer Study Group of Japan (1996) Registries in Japan: current status of hepatocellular carcinoma in Japan. Liver Cancer Study Group of Japan. Semin Surg Oncol 12:204–211CrossRefPubMed
Zurück zum Zitat Arii S, Yamaoka Y, Futagawa S, Inoue K, Kobayashi K, Kojiro M, Makuuchi M, Nakamura Y, Okita K, Yamada R (2000) Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. The Liver Cancer Study Group of Japan. Hepatology 32:1224–1229PubMed Arii S, Yamaoka Y, Futagawa S, Inoue K, Kobayashi K, Kojiro M, Makuuchi M, Nakamura Y, Okita K, Yamada R (2000) Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. The Liver Cancer Study Group of Japan. Hepatology 32:1224–1229PubMed
Zurück zum Zitat Bruix J, Llovet JM, Castells A, Montana X, Bru C, Ayuso MC, Vilana R, Rodes J (1998) Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution. Hepatology 27:1578–1583PubMed Bruix J, Llovet JM, Castells A, Montana X, Bru C, Ayuso MC, Vilana R, Rodes J (1998) Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution. Hepatology 27:1578–1583PubMed
Zurück zum Zitat Chung YH, Song IH, Song BC, Lee GC, Koh MS, Yoon HK, Lee YS, Sung KB, Suh DJ (2000) Combined therapy consisting of intraarterial cisplatin infusion and systemic interferon-alpha for hepatocellular carcinoma patients with major portal vein thrombosis or distant metastasis. Cancer 88:1986–1991CrossRefPubMed Chung YH, Song IH, Song BC, Lee GC, Koh MS, Yoon HK, Lee YS, Sung KB, Suh DJ (2000) Combined therapy consisting of intraarterial cisplatin infusion and systemic interferon-alpha for hepatocellular carcinoma patients with major portal vein thrombosis or distant metastasis. Cancer 88:1986–1991CrossRefPubMed
Zurück zum Zitat Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C, Wong J (1999) Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 229:322–330CrossRefPubMed Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C, Wong J (1999) Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 229:322–330CrossRefPubMed
Zurück zum Zitat Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, Takayama T, Makuuchi M (2003) One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 138:1198–1206CrossRefPubMed Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, Takayama T, Makuuchi M (2003) One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 138:1198–1206CrossRefPubMed
Zurück zum Zitat Inoue K, Makuuchi M, Takayama T, Torzilli G, Yamamoto J, Shimada K, Kosuge T, Yamasaki S, Konishi M, Kinoshita T, Miyagawa S, Kawasaki S (2000) Long-term survival and prognostic factors in the surgical treatment of mass-forming type cholangiocarcinoma. Surgery 27:498–505 Inoue K, Makuuchi M, Takayama T, Torzilli G, Yamamoto J, Shimada K, Kosuge T, Yamasaki S, Konishi M, Kinoshita T, Miyagawa S, Kawasaki S (2000) Long-term survival and prognostic factors in the surgical treatment of mass-forming type cholangiocarcinoma. Surgery 27:498–505
Zurück zum Zitat Jonas S, Bechstein WO, Steinmuller T, Herrmann M, Radke C, Berg T, Settmacher U, Neuhaus P (2001) Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis. Hepatology 33:1080–1086CrossRefPubMed Jonas S, Bechstein WO, Steinmuller T, Herrmann M, Radke C, Berg T, Settmacher U, Neuhaus P (2001) Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis. Hepatology 33:1080–1086CrossRefPubMed
Zurück zum Zitat Kato T, Saito Y, Niwa M, Ishiguro J, Ogoshi K (1994) Combination therapy of transcatheter chemoembolization and percutaneous ethanol injection therapy for hepatocellular carcinoma. Cancer Chemother Pharmacol 33:S115–S118PubMed Kato T, Saito Y, Niwa M, Ishiguro J, Ogoshi K (1994) Combination therapy of transcatheter chemoembolization and percutaneous ethanol injection therapy for hepatocellular carcinoma. Cancer Chemother Pharmacol 33:S115–S118PubMed
Zurück zum Zitat Konishi M, Ryu M, Kinoshita T, Inoue K (2001) Surgical treatment of hepatocellular carcinoma with direct removal of the tumor thrombus in the main portal vein. Hepatogastroenterology 48:1421–1424PubMed Konishi M, Ryu M, Kinoshita T, Inoue K (2001) Surgical treatment of hepatocellular carcinoma with direct removal of the tumor thrombus in the main portal vein. Hepatogastroenterology 48:1421–1424PubMed
Zurück zum Zitat Makuuchi M, Kosuge T, Takayama T, Yamazaki S, Kakazu T, Miyagawa S, Kawasaki S (1993) Surgery for small liver cancers. Semin Surg Oncol 9:298–304PubMed Makuuchi M, Kosuge T, Takayama T, Yamazaki S, Kakazu T, Miyagawa S, Kawasaki S (1993) Surgery for small liver cancers. Semin Surg Oncol 9:298–304PubMed
Zurück zum Zitat Seong J, Park HC, Han KH, Chon CY (2003) Clinical results and prognostic factors in radiotherapy for unresectable hepatocellular carcinoma: a retrospective study of 158 patients. Int J Radiat Oncol Biol Phys 55:329–336CrossRefPubMed Seong J, Park HC, Han KH, Chon CY (2003) Clinical results and prognostic factors in radiotherapy for unresectable hepatocellular carcinoma: a retrospective study of 158 patients. Int J Radiat Oncol Biol Phys 55:329–336CrossRefPubMed
Zurück zum Zitat Shimamura Y, Gunven P, Ishii M, Ono M, Abe K (1993) Debulking surgery and arterial embolization for unresectable liver cancer. Hepatogastroenterology 40:10–13PubMed Shimamura Y, Gunven P, Ishii M, Ono M, Abe K (1993) Debulking surgery and arterial embolization for unresectable liver cancer. Hepatogastroenterology 40:10–13PubMed
Zurück zum Zitat Takayama T, Makuuchi M, Hirohashi S, Sakamoto M, Yamamoto J, Shimada K, Kosuge T, Okada S, Takayasu K, Yamasaki S (1998) Early hepatocellular carcinoma as an entity with a high rate of surgical cure. Hepatology 28:1241–1246PubMed Takayama T, Makuuchi M, Hirohashi S, Sakamoto M, Yamamoto J, Shimada K, Kosuge T, Okada S, Takayasu K, Yamasaki S (1998) Early hepatocellular carcinoma as an entity with a high rate of surgical cure. Hepatology 28:1241–1246PubMed
Zurück zum Zitat Takayasu K, Suzuki M, Uesaka K, Muramatsu Y, Moriyama N, Yoshida, Kishi K, Hasagawa H, Okazaki N (1989) Hepatic artery embolization for inoperable hepatocellular carcinoma; prognosis and risk factors. Cancer Chemother Pharmacol 23:S123–S125PubMed Takayasu K, Suzuki M, Uesaka K, Muramatsu Y, Moriyama N, Yoshida, Kishi K, Hasagawa H, Okazaki N (1989) Hepatic artery embolization for inoperable hepatocellular carcinoma; prognosis and risk factors. Cancer Chemother Pharmacol 23:S123–S125PubMed
Zurück zum Zitat Tanaka K, Nakamura S, Numata K, Okazaki H, Endo O, Inoue S, Takamura Y, Sugiyama M, Ohaki Y (1992) Hepatocellular carcinoma: treatment with percutaneous ethanol injection and transcatheter arterial embolization. Radiology 185:457–460PubMed Tanaka K, Nakamura S, Numata K, Okazaki H, Endo O, Inoue S, Takamura Y, Sugiyama M, Ohaki Y (1992) Hepatocellular carcinoma: treatment with percutaneous ethanol injection and transcatheter arterial embolization. Radiology 185:457–460PubMed
Zurück zum Zitat Torzilli G, Makuuchi M, Inoue K, Takayama T, Sakamoto Y, Sugawara Y, Kubota K, Zucchi A (1999) No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: is there a way? A prospective analysis of our approach. Arch Surg 134:984–992PubMed Torzilli G, Makuuchi M, Inoue K, Takayama T, Sakamoto Y, Sugawara Y, Kubota K, Zucchi A (1999) No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: is there a way? A prospective analysis of our approach. Arch Surg 134:984–992PubMed
Zurück zum Zitat Wakabayashi H, Ushiyama T, Ishimura K, Izuishi K, Karasawa Y, Masaki T, Watanabe S, Kuriyama S, Maeta H (2003) Significance of reduction surgery in multidisciplinary treatment of advanced hepatocellular carcinoma with multiple intrahepatic lesions. J Surg Oncol 82:98–103CrossRefPubMed Wakabayashi H, Ushiyama T, Ishimura K, Izuishi K, Karasawa Y, Masaki T, Watanabe S, Kuriyama S, Maeta H (2003) Significance of reduction surgery in multidisciplinary treatment of advanced hepatocellular carcinoma with multiple intrahepatic lesions. J Surg Oncol 82:98–103CrossRefPubMed
Zurück zum Zitat Watanabe T, Omori M, Fukuda H, Takada H, Miyao M, Mizuno Y, Ohsawa I, Sato Y, Hasegawa T (2003) Analysis of sex, age and disease factors contributing to prolonged life expectancy at birth, in cases of malignant neoplasms in Japan. J Epidemiol 13:169–175PubMed Watanabe T, Omori M, Fukuda H, Takada H, Miyao M, Mizuno Y, Ohsawa I, Sato Y, Hasegawa T (2003) Analysis of sex, age and disease factors contributing to prolonged life expectancy at birth, in cases of malignant neoplasms in Japan. J Epidemiol 13:169–175PubMed
Zurück zum Zitat Yamamoto K, Takenaka K, Kawahara N, Shimada M, Shirabe K, Itasaka H, Nishizaki T, Yanaga K, Sugimachi K (1997) Indications for palliative reduction surgery in advanced hepatocellular carcinoma. The use of a remnant tumor index. Arch Surg 132:120–123PubMed Yamamoto K, Takenaka K, Kawahara N, Shimada M, Shirabe K, Itasaka H, Nishizaki T, Yanaga K, Sugimachi K (1997) Indications for palliative reduction surgery in advanced hepatocellular carcinoma. The use of a remnant tumor index. Arch Surg 132:120–123PubMed
Zurück zum Zitat Yamamoto M, Iizuka H, Matsuda M, Nagahori K, Miura K, Itakura J (1993) The indications for tumor mass reduction surgery and subsequent multidisciplinary treatments in stage IV hepatocellular carcinoma. Surg Today 23:675–681PubMed Yamamoto M, Iizuka H, Matsuda M, Nagahori K, Miura K, Itakura J (1993) The indications for tumor mass reduction surgery and subsequent multidisciplinary treatments in stage IV hepatocellular carcinoma. Surg Today 23:675–681PubMed
Metadaten
Titel
Volume reduction surgery for advanced hepatocellular carcinoma
verfasst von
Kazuto Inoue
Takayuki Nakamura
Taira Kinoshita
Masaru Konishi
Toshio Nakagohri
Tatsuya Oda
Shinichiro Takahashi
Naoto Gotohda
Takayuki Hayashi
Shigeru Nawano
Publikationsdatum
01.06.2004
Verlag
Springer-Verlag
Erschienen in
Journal of Cancer Research and Clinical Oncology / Ausgabe 6/2004
Print ISSN: 0171-5216
Elektronische ISSN: 1432-1335
DOI
https://doi.org/10.1007/s00432-004-0566-7

Weitere Artikel der Ausgabe 6/2004

Journal of Cancer Research and Clinical Oncology 6/2004 Zur Ausgabe

Positiver FIT: Die Ursache liegt nicht immer im Dickdarm

27.05.2024 Blut im Stuhl Nachrichten

Immunchemischer Stuhltest positiv, Koloskopie negativ – in solchen Fällen kann die Blutungsquelle auch weiter proximal sitzen. Ein Forschungsteam hat nachgesehen, wie häufig und in welchen Lokalisationen das der Fall ist.

Mammakarzinom: Brustdichte beeinflusst rezidivfreies Überleben

26.05.2024 Mammakarzinom Nachrichten

Frauen, die zum Zeitpunkt der Brustkrebsdiagnose eine hohe mammografische Brustdichte aufweisen, haben ein erhöhtes Risiko für ein baldiges Rezidiv, legen neue Daten nahe.

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

24.05.2024 Mammakarzinom Nachrichten

In der MONARCHE-3-Studie lebten Frauen mit fortgeschrittenem Hormonrezeptor-positivem, HER2-negativem Brustkrebs länger, wenn sie zusätzlich zu einem nicht steroidalen Aromatasehemmer mit Abemaciclib behandelt wurden; allerdings verfehlte der numerische Zugewinn die statistische Signifikanz.

ADT zur Radiatio nach Prostatektomie: Wenn, dann wohl länger

24.05.2024 Prostatakarzinom Nachrichten

Welchen Nutzen es trägt, wenn die Strahlentherapie nach radikaler Prostatektomie um eine Androgendeprivation ergänzt wird, hat die RADICALS-HD-Studie untersucht. Nun liegen die Ergebnisse vor. Sie sprechen für länger dauernden Hormonentzug.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.