[Two-stage resection for advanced hepatocellular carcinoma--preliminary results of 13 cases]

We performed two-stage resection for thirteen patients with advanced hepatocellular carcinoma from January 1987 to January 1991. All patients underwent various surgical therapies prior to resection which included gauze packing hemostasis in 1 case, hyperthermia plus radiotherapy in 1, hepatic arterial ligation in 2, operative hepatic arterial embolization in 1, and transcatheter embolization in 8. The median interval between the first therapy and tumor resection was 54 days with a range of 29-769 days and the median diameter of tumors decreased from 10.5 cm to 7.5 cm. The majority of procedures on two-stage resection were irregular hepatectomy or lobectomy under occlusion of porta hepatis. Regular hepatectomies were done in 4 cases. Pathological examination showed complete coagulation necrosis in 3 specimens. However, in the others were still found residual viable tumor cells outside or beneath the tumor capsule with varying degrees of necrosis within the tumors. Survival periods of the patients who received two-stage resection were from 4 months to 4 years except 2 operative death. The significance, possibility as well as methods of two-stage resection were discussed.