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February 1997

Indications for Palliative Reduction Surgery in Advanced Hepatocellular Carcinoma: The Use of a Remnant Tumor Index

Author Affiliations

From the Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.

Arch Surg. 1997;132(2):120-123. doi:10.1001/archsurg.1997.01430260018002

Objectives:  To clarify the indications for and the significance of palliative reduction surgery in the multidisciplinary treatment of advanced hepatocellular carcinoma (HCC) and to propose the use of a remnant tumor index (RTI) as a simplified criterion for palliative reduction surgery in cases of advanced HCC.

Design:  A comparison of survival based on the RTI.

Setting:  A large university hospital in Japan.

Patients:  Twenty-five patients with advanced HCC who underwent palliative reduction surgery were divided into 3 groups as follows: group 1 (n=9), the remnant tumor after operation existed only in the liver and the RTI was less than 5.0; group 2 (n=11), the remnant tumor after operation existed only in the liver and the RTI was greater than 5.0; and group 3 (n=5), extrahepatic metastatic tumor existed after operation.

Main Outcome Measures:  Pathological findings and survival rate after surgery.

Results:  There was no significant difference in the degree of macroscopic intrahepatic metastases among the 3 groups; however, both the portal vein invasion and the histological grade tended to be more severe in groups 2 and 3. The respective 1-year and 3-year survival rates for group 1 were 67% and 33%, and those for group 2 were 21% and 0%. There were no survivors in group 3 at 1 year after surgery. Significant differences were found in the survival rates between groups 1 and 2 (P<.05), and between groups 1 and 3 (P<.05).

Conclusion:  Palliative reduction surgery for advanced HCC is only considered effective for patients with both an RTI of less than 5.0 and no extrahepatic metastasis.Arch Surg. 1997;132:120-123

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