LIVER CANCER
Keywords:
HCC, CHC, liver disease, diagnostic procedures, surgical treatment LIVERAbstract
Background. Liver cancer is the most frequent malignant tumor of the solid organs in the world, but it is relatively rare in Slovenia. Because of the hepatitis C spreading we can expect a considerable rise of hepatocellular carcinoma also in Slovenia. For diagnosis angiography with Lipiodol and CT scan after10 days is a useful method. AFP is elevated only in 60% of patients. The stage of liver disease is crucial for the treatment. The only possibility to cure these tumors is surgical removal when possible with segment oriented liver resection. For small HCC in decompensated cirrhosis liver transplantation is the treatment of choice. Good results in small tumors in advanced cirrhosis have been reported also using ablation methods or intersticial therapy. Recurrence is frequent and repeated surgical treatment is possible in about 50% of the patients.
Patients and methods. A two years review of surgical treatment of liver tumors in Slovenia is presented. We included patients with HCC and cholangiocarcinoma (parenchymal and hillar). There was 21 patient with HCC and 23 patients with cholangiokarcinoma treated in two centers (Ljubljana and Maribor). Chronic liver disease was found in only 30% of patients with HCC. Liver resection was performed in 35 patients; hepatectomy in 5 patients and segmental resection or wedge resection in 30 patients. There was 30% morbidity and 2.2% mortality in this group of patients.
Conclusions. We can conclude that only a small part of patients with HCC in Slovenia are being treated surgically, although our results of surgery are comparable with those from other specialized surgical institutions abroad.
Downloads
References
International Hepatology Informatics Group. Diseases of the liver and biliary tract. New York: Raven Press, 1994: 165–79.
Okuda K, Ohtsuki T, Obata H. Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Cancer 1985; 56: 918–28.
Gadžijev EM. Rak jeter, žolčnika in žolčnih vodov. In: Repše S ed. Priporočila za celostno obravnavo bolnikov z rakom prebavil. Ljubljana: Ministrstvo za zdravstvo R Slovenije,1997: 33–52.
Virji MA, Piper M, Carr BI. Alfa-feto protein and des-gamma-carboxy prothrombin in hepatocellular carcinoma and chronic liver disease. Hepatology 1992; 16: 538–8.
Makuuchi M. Remodeling the surgical approach to hepatocellular carcinoma. Hepato-Gastroenterology 2002; 49: 36–40.
Imamura H, Shimada R, Kubota M, Matsuyama Y, Nakayama A, Miyagawa S, Makuuchi M, Kawasaki S. Preoperative portal vein embolization. An audit of 84 patients. Hepatology 1999; 29: 1099–105.
Carr BI. Hepatic artery chemoembolization for advanced stage HCC: Experience of 650 patients. Hepato-Gastroenterology 2002; 49: 79–86.
Higashihara H, Okazaki M. Transchateter arterial chemoembolization of hepatocellular carcinoma: a japanese experience. Hepato-Gastroenterology 2002; 49: 72–8.
Livraghi T, Giorgio A, Marin G. Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology 1995; 197: 101–8.
Montorsi M, Santambrogio R, Bianchi P et al. Laparoscopic radiofrequency of hepatocellular carcinoma (HCC) in liver cirrhosis. Hepato-Gastroenterology 2001; 48: 41–5.
Montorsi M, Santambrogio R, Bianchi P, Dapri G, Spinelli A, Podda M. Perspectives and drawbacs of minimally invasive surgery for hepatocellular carcinoma. Hepato-Gastroenterology 2002; 49: 56–61.
Huscher CG, Lirici MM, Chiodini S. Laparoscopic liver resection. Semin Laparosc Surg 1998; 5: 204–10.
Fan ST. Methods and related drawbacs in the estimation of surgical risks in cirrhotic patients undergoing hepatectomy. Hepato-Gastroenterology 2002; 49: 17–20.
Bismuth H, Chiche L, Adam R, Castaing D, Diamond T, Dennison A. Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg 1993; 218: 145–51.
Durand F, Belghiti J. Liver transplantation for hepatocellular carcinoma. Hepato-Gastroenterology 2002; 49: 47–52.
Ringe B, Wittekind C, Weimann A, Tusch G, Pichlmayr R. Results of hepatic resection and transplantation for fibrolamellar carcinoma. Surg Gynecol Obstst 1992; 175: 299–305.
Pinna AD, Iwatsuki S, Lee RG et al. Treatment of fibrolamellar hepatoma with subtotalhepatectomy or transplantation. Hepatology 1997; 26: 877– 83.
Fong Y, Sun RL, Jarnagin W, Blumgart LH. An analysis of 412 cases of hepatocellular carcinoma at a western center. Ann Surg 1999; 229: 790– 800.
Schwartz ME, Sung M, Mor E. A multidisciplinary approach to hepatocellular carcinoma in patients with cirrhosis. I Am Coll Surg 1995; 180: 596– 603.
Downloads
Issue
Section
License
The Author transfers to the Publisher (Slovenian Medical Association) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Slovenian Medical Association) has the right to transfer the rights of acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.