Treatment choice for hepatocellular carcinoma from surgical standpoint

The choice of treatments for hepatocellular carcinoma (HCC) was discussed from surgical stand point using our results and reports of other institutes. At present, three principal modalities such as hepatectomy, percutaneous ethanol injection therapy (PEIT) and TAE are adopted according to the size and number of nodules, degree of liver dysfunction, patient\u27s clinical stage, and availability in each institute. Furthermore, percutaneous acetic acid injection therapy (PAIT) and microwave coagulation therapy (MCT) are devised recently and seem to be favorable. The 5 year cumulative survival rate after partial hepatectomy for our 49 cases was 54.4%. This result seems to be higher than those after PEIT or TAE, however the 5 year recurrence rate was as high as 79.3%, similar to that of PEIT. These recurrence cases after hepatectomy includes both intra hepatic metastasis and multicentric carcinogenesis. Of the latter mode of recurrence, at least 35% of those are regarded as metachronous multicentric carcinogenesis, suggesting the limitation of surgical intervention. PEIT has been indicated for tumors less than 3 cm in diameter. The rate at which PEIT achieved complete necrosis in main tumor is high, but the effective rate in lesion of extra capsular invasion is not high. For tumors more than 3 cm in diameter, PEIT could hardly obtain the complete therapeutic effect in the majority of cases, and surgical therapy is to be recommended except for cases with severe hepatic dysfunction