Results of surgical treatments of primary hepatocellular carcinoma: Some aspects to improve long‐term survival

Abstract From 1973 through 1982 we have treated 226 patients with primary hepatocellular carcinoma, including 103 by hepatectomy and 93 by hepatic artery ligation. Most were associated with cirrhosis or related liver diseases and one‐third with esophageal varices. As in other Japanese and Asian series, our long‐term overall results for the 90 patients who survived hepatectomy were poor in comparison with Western series dealing with non‐cirrhotic patients. However, the actuarial survival rate at 3 years was 90% in patients with carcinomas smaller than 3 cm in diameter (n = 18). The 5‐year survival rate was 70.8% in the 25 patients whose carcinoma had a curative resection, and 100% at 3 years in the 16 patients in whom a tumor smaller than 5 cm had been resected. Eighty‐four patients survived hepatic artery ligation; in 50 of them the area of ischemia was thought to include all the neoplastic lesions within the liver. The survival rate of these 50 patients was superior to that of the patients who had undergone noncurative hepatic resection. We conclude that early detection and curative resection is the best way to improve the long‐term results in cirrhotic patients with hepatocellular carcinoma and that hepatic artery ligation is better than incomplete (noncurative) resection .