Surgical approaches for improving the operating results of primary liver cancer

The purpose of this study was to retrospectively analyse the results of 1102 primary liver cancer (PLC) patients who underwent liver resection in the past thirty years and to research some effective approaches for improving the longterm effect of PLC treatment. Ninety five percent were hepatocellular carcinoma (HCC), 85.2% with cirrhosis of hepatitis and 25.6% with tumor equal to or smaller than 5 cm in diameter. The mortality rate (MR) within 1 month after operation was 1.8%, the operative MR was 8.8% before 1977 and only 0.4% after that. The total 5-year survival rate (SR) was 28.4% while in the group of small tumor (less than or equal to 5 cm), it was 75.0%. Our experience is as follows: (1) Early diagnosis and early resection of PLC is the key point for improving the operative result of long-term survival. In 282 cases of small cancer, tumor resection rate was 90.0%. Of 48 cases with tumor equal to or smaller than 3 cm in diameter, the 5-year SR was 83.3%. (2) Rehepatectomy for recurrent liver cancer is an important approach for improving the surgical result. In our series, recurrent rate within 5 years postoperation was 72.3% in larger tumor group and 34.5% in small tumors. There were 78 cases undergoing reoperation in a total number of 170 times of rehepatectomy with 54.7% of 5-year SR, after the 1st operation and 34.6% after the 2nd one. (3) For unresectable large tumors, two-stage operation is an important development in liver surgery. We had 26 cases of such patients with 60.0% of 5-year SR. (4) Improvement of operating techniques plays an important role in reducing postoperative complications, lowering operative mortality and obtaining better operative result. (5) Postoperative comprehensive treatment is also important for solidating operative effect and preventing tumor recurrence.