Volume reduction surgery for advanced hepatocellular carcinoma.

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Interventional radiology

Background:

• Advanced hepatocellular carcinoma (HCC) presents significant treatment challenges.
• Large primary tumors (>10 cm) with multiple intrahepatic metastases (>5 nodules) often have a poor prognosis.
• Identifying effective treatment strategies for advanced HCC is crucial for improving patient outcomes.

Purpose of the Study:

• To assess the prognostic value of reductive surgery in patients with advanced HCC.
• To evaluate the impact of surgical debulking combined with transcatheter hepatic arterial chemo-embolization (TAE) on survival.
• To determine if this combined approach benefits patients with large HCC and intrahepatic spread.

Main Methods:

• Prospective enrollment of 13 patients with advanced HCC (main tumor >10 cm, >5 metastases, Child-Pugh A, no portal vein thrombus).
• Surgical removal of the main tumor, with metastases managed by repeated TAE.
• Median follow-up and treatment details recorded.

Main Results:

• No major surgical complications were noted, with a median hospital stay of 12 days.
• Patients received a median of 5 TAE sessions post-surgery.
• Overall 1-, 3-, and 4-year survival rates were 67.7%, 40.6%, and 40.6%, respectively, with some patients achieving long-term remission.

Conclusions:

• Volume reduction surgery followed by TAE may extend survival in advanced HCC patients with large tumors and metastases.
• This strategy appears particularly beneficial for patients with right-sided main tumors.
• Further research may validate this approach for selected HCC cases.