[Surgical treatment of primary liver cancer]

The mortality rate of patients with primary liver cancer (PLC) was 20.40 per 100,000 Chinese per year, that takes the second place among all forms of cancer. Surgical resection remains the modality of primary choice in the treatment of PLC. 2051 patients with PLC were treated by liver resection from 1960 to 1993. Of those, 94.1% were hepatocellular carcinoma (HCC) and the incidence of cirrhosis and chronic hepatitis was found in 86.5%. Small PLC (< or = 5 cm in diameter) was found in 25.1% of all cases. In the small PLC group, 176 cases were found the tumor < or = 3 cm in diameter. All 2051 patients received liver resection and 44.0% of them had local radical resection. The overall mortality rate within one month after operation was 1.1%. The overall 5-year survival rate was 36.1%. Improved surgical result was obtained in 515 patients with small PLC (< or = 5 cm in diameter). No operative death occurred in this group and the 5-year survival rate was 79.8%. Moreover, the patients with very small PLC (< or = 3 cm in diameter) prolonged their survival. The 5-year survival rate was 85.3%. Early diagnosis and early resection of PLC are one of the key points for improving the long-term results. Improvements in operative techniques play an important role in reducing post-operative complications, lowering operative mortality and obtaining better operative results. Rehepatectomy for recurrent liver cancer can improve the surgical results. 95 patients underwent rehepatectomy with a 5-year survival rate of 53.2% and 25.0% after the first and second operation respectively. One patient survived 18 years. For unresectable large tumors, two-stage resection can be used. We collected 659 cases of large unresectable tumors from 1974 to 1994. Among them, 73 cases were resected in two-stage operation. The resection rate was 11.1%, and the 5-year survival rate was 61.5%. Postoperative comprehensive treatment is also important for upregulating cellular immunological function, preventing tumor recurrence, and improving surgical results.