[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
June 1984

Hepatocellular CarcinomaChanging Concepts in Diagnosis and Management

Author Affiliations

From the Department of Surgery, University of California at San Francisco General Hospital.

Arch Surg. 1984;119(6):637-642. doi:10.1001/archsurg.1984.01390180005001

• We studied 86 cases of hepatocellular carcinoma treated between 1968 and 1982. All other liver tumors were excluded. There were 73 male and 13 female patients (average age, 59 years). The most frequent symptoms were pain (73%), weight loss (56%), and increased abdominal girth (23%). The α1-fetoprotein level was elevated in 23 of 32 patients, and the hepatitis B surface antigen was positive in 15 of 36. Significant differences in the hematocrit reading and total bilirubin and total protein levels were found between those patients with resectable and unresectable tumors. Forty-six patients underwent laparotomy, with a resection rate of 48%. There were six right hepatic lobectomies, four left hepatic lobectomies, and 12 trisegmentectomies. The long-term survival in patients who underwent laparotomy and biopsy only was 4.2 months, while those who underwent resection had an average longevity of 18.7 months (the longest was 11.5 years). Using new imaging techniques, the extent of tumor involvement and operability can be determined with greater accuracy. Criteria for resectability include (1) the absence of vena caval occlusion, (2) the lack of spread between lobes, (3) the absence of portal vein obstruction, and (4) the lack of extrahepatic metastasis.

(Arch Surg 1984;119:637-642)

Szmuness W:  Hepatocellular carcinoma and the hepatitis B virus: Evidence for a causal relation . Prog Med Virol 1978;24:40-48.
Coady A:  The aflatoxin-hepatoma-HBsAg story . Br Med J 1975;3: 592-593.
Brechot C, Nalpas B, Courouce A-M, et al:  Evidence that hepatitis B virus has a role in liver-cell carcinoma in alcoholic liver disease . N Engl J Med 1982;306:1384-1387.Article
Beasley RP, Hwang LY, Lin CC, et al:  Hepatocellular carcinoma and hepatitis B virus . Lancet 1981;2:1129-1133.Article
Lin TY:  The results of hepatic lobectomy for primary carcinoma of the liver . Surg Gynecol Obst 1966;123:289-294.
Ong GB, Lee NW:  Hepatic resection . Br J Surg 1975;62:421-430.Article
Okuda K:  Primary liver cancers in Japan . Cancer 1980;45:2663-2669.Article
Shanghai Coordinating Group:  Diagnosis and treatment of primary hepatocellular carcinoma in early stage . Chin Med J Engl 1979;92:801-806.
Edmondson HA, Steine PE:  Primary carcinoma of the liver . Cancer 1954;7:462-500.Article
Honjo I, Mizumoto R:  Primary carcinoma of the liver . Am J Surg 1974;128:31-36.Article
Fortner JG, Kim DK, Maclean BJ, et al:  Major hepatic resection for neoplasia: Personal experience in 108 patients . Ann Surg 1978;188:363-371.Article
Adson MA, Sheedy PF:  Resection of primary hepatic malignant lesions . Arch Surg 1974;108:599-604.Article
Adson MA, Wiland LH:  Resection of primary solid hepatic tumors . Am J Surg 1981;141:18-21.Article
Kew MC, Dos Santos HA, Sherlock S:  Diagnosis of primary cancer of the liver . Br Med J 1971;4:408-411.Article
Purtilo DT, Kersey JH, Hallgren HM, et al:  Alpha-fetoprotein: Diagnostic and prognostic use in patients with hepatomas . J Clin Pathol 1973;59:295-299.
Glickman MG, Handel SF:  Opacification of hepatic veins during celiac and hepatic angiography . Radiology 1972;103:565-571.Article