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Hepatocellular carcinoma: multimodality management. Surgery 2001 Oct;130(4):554-9; discussion 559-60

Date

10/17/2001

Pubmed ID

11602884

DOI

10.1067/msy.2001.117106

Scopus ID

2-s2.0-0034788280   25 Citations

Abstract

BACKGROUND: Hepatocellular carcinoma is one of the most common tumors worldwide. Surgical resection has been the standard treatment but can only be applied to a small percentage of patients. In recent years, several other treatment options, including ablative procedures and transplantation, have been used in patients with hepatocellular carcinoma.

METHODS: For 6 years, 110 patients with hepatocellular carcinoma were managed at the Medical College of Wisconsin. Fifty-five patients received only chemotherapy (n = 5) or palliative treatment (n = 50) because of advanced cirrhosis (P <.03) or tumor. Thirty-one patients had tumor ablation with percutaneous ethanol injection, cryoablation, radiofrequency ablation, or arterial chemoembolization. Twenty-eight patients underwent surgical resection (n = 18) or hepatic transplantation (n = 10). Relatively more patients (38%; P <.001) were treated with ablation in the second period of the study (1998-2000).

RESULTS: Thirty-day mortality was 3% with ablation and 0% with resection. Median survival was 6 months with no treatment, 27 months with ablation (P <.001), and 35 months with resection (P <.001). Patients who underwent liver transplantation had the longest median survival (53 months). A multivariate analysis suggested that treatment modality (ablation or resection; P <.001) and Child-Pugh classification (P <.01) were the most important factors predicting outcome.

CONCLUSIONS: This study suggests that treatment of hepatocellular carcinoma requires multidisciplinary expertise and that ablation and operation can be performed safely. Outcome is influenced most by treatment modality and Child-Pugh classification. Patients in Child-Pugh classes A and B should be treated with ablation, surgical resection, or liver transplantation.

Author List

Christians KK, Pitt HA, Rilling WS, Franco J, Quiroz FA, Adams MB, Wallace JR, Quebbeman EJ

Authors

Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
William S. Rilling MD, FSIR Vice Chair, Professor in the Radiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Carcinoma, Hepatocellular
Chemoembolization, Therapeutic
Combined Modality Therapy
Cryotherapy
Ethanol
Female
Humans
Liver Neoplasms
Male
Middle Aged
Multivariate Analysis