[Development of the surgical therapy of malignant liver tumors]

The development of surgical treatment for malignant liver tumor was reviewed. The developmental process can apparently be divided into four periods. The first period up to 1968 is when surgical trials for liver tumors were started, and much effort was directed toward the establishment of systematic procedures for hepatic resection. The second period starts form 1968, when the Liver Cancer Study Group of Japan was inaugurated to organize investigators participating in the treatment of, and basic research on liver tumors. During this period, the basis for contemporary surgical treatment and sophisticated means of diagnosis such as such as determination of serum AFP level, selective angiography, and liver scintigraphy were established. This period came to an end around 1977 when computed tomography and ultrasonography were developed and popularized. In the third period, a variety of procedures for hepatic resection such as lobectomy, segmentectomy and newly devised echo-guided sub-segmentectomy were performed, based on the close evaluation of hepatic functional reserve. However, analysis of the outcome in patients who had undergone surgery alone suggested the limitations of surgical treatment, leading to the advent of the 4th period two to three years ago. The strategy of therapy in the 4th period has been aimed at multidisciplinary treatment such as transarterial embolization, intratumoral injection of tumoricidal agents, radiotherapy, regional chemotherapy and immunotherapy.