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The surgical approach to HCC: our progress and results in Japan
Masatoshi Makuuchi1, Keiji Sano
1Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. makuuchi-tky@umin.ac.jp
Insights
Japanese surgeons have developed advanced hepatectomy and living-donor liver transplantation techniques for hepatocellular carcinoma (HCC). These innovations significantly reduce operative mortality and improve survival rates for HCC patients in Japan.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Transplantation Medicine
Background:
- High incidence of hepatocellular carcinoma (HCC) in Japan, often linked to hepatitis virus infections.
- Need for advanced surgical strategies to manage HCC, including challenging cases and liver transplantation.
Purpose of the Study:
- To review and highlight Japanese surgical advancements in hepatectomy for HCC.
- To present outcomes of living-donor liver transplantation (LDLT) for HCC in Japan.
Main Methods:
- Development and application of novel hepatectomy techniques: precise functional reserve evaluation, portal venous embolization, intraoperative ultrasonography-guided resections, and intermittent inflow occlusion.
- Surgical management of advanced HCC: addressing portal/hepatic venous tumor thrombus, multiple/recurrent HCC, and caudate lobe tumors.
- Advancements in LDLT for HCC: pioneering adult-to-adult transplants with various graft types (left, right, extended grafts) and reconstruction techniques.
Main Results:
- National survey shows 0.9% operative mortality and 52% 5-year survival for HCC hepatectomy.
- LDLT series of 36 HCC patients: 3% operative mortality and 84% 2-year survival rate.
Conclusions:
- Japanese surgical innovations have significantly improved outcomes for HCC hepatectomy.
- Living-donor liver transplantation is a viable and effective treatment for HCC, offering high survival rates.
Abstract:
Due to the prevalence of hepatitis virus infection, the incidence of hepatocellular carcinoma (HCC) is very high in Japan. Many techniques have been devised by Japanese surgeons to reduce the mortality rate after hepatectomy for HCC: preoperative precise evaluation of hepatic functional reserve, portal venous embolization as preoperative preparation, anatomical and nonanatomical limited resections using intraoperative ultrasonography, and intermittent inflow occlusion during liver transection. Several challenging surgical procedures are also being tried for advanced HCC: HCC with portal and hepatic venous tumor thrombus, multiple and/or recurrent HCC, and HCC in the caudate lobe. As a result, the latest national survey of HCC revealed that operative mortality was 0.9% and the 5-year survival rate after surgery was 52%. Living-donor liver transplantation for adult patients with HCC is another surgical treatment developed in Japan. After the success of adult-to-adult living donor liver transplant using a left liver graft in 1993, a right liver graft, a left liver graft with caudate lobe, and a right lateral sector graft were developed. Indications for reconstructing the middle hepatic vein tributaries in right liver grafts were also proposed. Consequently, in our series of 36 patients with HCC who underwent living-donor liver transplantation, operative mortality was 3%, and the 2-year survival rate was 84%.
