| Theme | Controversies Over Diagnosis and Treatment of Hepatocellular Carcinoma | |
|---|---|---|
| Title | Can Hepatocellular Carcinomas (larger than 3cm) be Curatively Treated with Local Ablation Therapy? | |
| Publish Date | 2002/08 | |
| Author | Toru Beppu | Department of Surgery II, Kumamoto University Medical School |
| Author | Koichi Doi | Department of Surgery II, Kumamoto University Medical School |
| Author | Takatoshi Isiko | Department of Surgery II, Kumamoto University Medical School |
| Author | Michio Ogawa | Department of Surgery II, Kumamoto University Medical School |
| [ Summary ] | Hepatocellular carcinomas (HCCs) larger than 3cm must be treated with operative local ablation therapy (LAT); percutaneous, endoscopic and open approaches, under general anesthesia. The endoscopic approach is the option of first choice. IVR-CT, CO2-angio US and artificial hydrothorax are useful in the percutaneous approach. Radio-frequency ablation (RFA) can form a large coagulative area without high risk, so it is recommended as a principal coagulative method. Transcatheter arterial chemoembolization (TACE), cooling procedure for the bile duct and hand-assissted laparoscopic surgery are useful toextend the indications for LAT. Our results in 195 patients with large HCCs indicate that the 5-year cumulative survival rate is 39% in LAT, 52% in hepatic resection and 11% in TACE, respectively. The local recurrence rate after LAT is 18% in large HCCs and 9% in small HCCs, respectively. We can achieve complete responses in all cases according to the criteria for tumor necrosis effects. In conclusion, LAT must be selected in the following cases: inoperable cases, high risk cases and cases with good prospects for LAT. | |