[Improving early and late results of hepatectomy for HCC]

The present study reports how we indicate safe and beneficial hepatectomy for hepatocellular carcinomas from the experiences of the consecutive 335 patients treated during 1973 and Dec. 1988. The first question was to appreciate the preoperative prediction of a safe limit of hepatectomy. We established a multiple regression formula consisting of several factors such as CT estimated resection rate, ICG retention rate and patient's age at the end of 1980. Since the beginning of 1981, we have been employing the formula as a major indicator guiding treatment option, leading to a significant drop of postoperative, liver failure. The influencing prognostic factors have been determined to be vascular invasion, intrahepatic metastasis, extent of resection regulated by hepatic reserve and tumor size in the decreasing order. From the viewpoint of the biological aspect, the tumors with DNA diploid pattern showed significantly better prognosis than those with non-diploid ones. The current surgical techniques of hepatectomies with en-bloc ligation of Glisson's vessels or with vascular exclusion supported by veno-venous bypass have greatly encouraged the recent surgical results achieving 56% of 4-year survival rate (1985-1988).