[Surgery-predominant comprehensive therapy for 134 patients with small hepatocellular carcinoma]

Although surgical resection is the primary choice modality in treatment of small hepatocellular carcinoma(HCC), the 5-year recurrent rate after resection was as high as 35.4%-43.5%. This study was designed to investigate the efficacy of surgery-predominant comprehensive therapy for small HCC in reducing the recurrent rate and improving the outcome.

A total of 134 cases of small HCC (< or = 5 cm in diameter) received surgery-predominant comprehensive treatment in The Affiliated Tumor Hospital, Guangxi Medical University from 1985 to 2001. The median age of the patients was 45 years old (range,18-70 years). Of 134 cases, 121 were treated with hepatectomy: 16 with irregular hepatectomy, 83 with local radical resection, 12 with regular liver lobe resection or liver segment resection, 2 with left semi-hepatectomy, and 8 with hepatectomy and gallbladder resection. In the other 13 cases of nonresectable small HCC, they received multimodality treatments by various combinations of hepatic artery ligation and anticancer agents by hepatic artery infusion, microwave coagulation, ethanol injection into tumor, cryosurgery,radio-frequency (RF), and hepatic artery chemoembolization therapy.

Of 134 HCC patients, 90.3% received liver resection and no operative death occurred. For the surgery group, the 1-, 3-, 5-, and 10-year survival rates were 89.3%, 74.4%, 64.6%, and 43.8%, respectively; the 1-, 3-, and 5-year recurrent rates were 11.9%, 23.8%, and 32.1%, respectively. For the total group,the 1-, 3-,5-, and 10-year survival rates were 88.8%, 72.2%, 63.4%, and 41.7%, respectively; the 1-, 3-, and 5-year recurrent rates were 15.9%, 29.1%, and 36.6%, respectively.

Surgical resection remains primary choice modality in treatment of small HCC; postoperative comprehensive treatment is important for preventing tumor recurrence and improving the long-term results.