Gigantic hepatocellular carcinoma, treated by transcatheter oily chemoembolization (TOCE) and wedge hepatic resection

Four cases of gigantic hepatocellular carcinoma, considered by surgeons to be inoperable, were treated with repeated transcatheter chemoembolization (TOCE) until the serum alfafetoprotein reduced to normal or less than half of the original level or until the tumor reduced to less than half of the original size documented by CT scan and angiogram. Wedge hepatic resection was performed using ultrasonic dissector. Histologic section of the resected tumor mass revealed tumor necrosis. The extent of tumor necrosis was related to tumor size and corresponded inversely to the thickness of the tumor capsule. The survival periods were 48 to 108 months with only one to two episodes of recurrence during follow-up. Repeated wedge hepatic resection was performed successfully for recurrent cases. Serum alfafetoprotein (AFP) is a very sensitive and reliable tumor marker for follow-up results and appears to be a sensitive indicator for tumor recurrence.