[Surgical management of patients with hepatic carcinoma]

The results of hepatectomy for patients with hepatocellular carcinoma are hampered by the formidable postoperative morbidity and mortality rates and frequent recurrences on follow-up. Our recent analysis of 343 patients who had hepatectomy in the past 22 years demonstrated a significant improvement of results. A decision for hepatectomy and its permissible extent, is based on a thorough preoperative assessment of the hepatic reserve with a combination of indocyanine green retention rate measurement and computed tomography. For difficult right lobe tumors, such as those infiltrating the diaphragm and posterior abdominal wall, parenchymal transection would be performed without prior mobilization of the right hepatic lobe for selected patients. In addition, perioperative parental branched chain amino-acid infusion is another option which might help in reducing postoperative morbidity rate in cirrhotic patients. The survival rates of patients managed after 1987 demonstrated a significant increase, with a 5-year survival rate of 35 percent though with a steady recurrent rate. The use of intra-arterial oily chemoembolization with an emulsion of lipiodol and cisplatinum, and intra-lesional alcohol injection under percutaneous ultrasound guidance, allowed effective control of intrahepatic diseases. Since 1990, postoperative adjuvant chemotherapy using a combination of systemic and regional chemotherapy has been used in the reduction of recurrent tumours.