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The surgical approach to HCC: Our progress and results in Japan
Author(s) -
Makuuchi Masatoshi,
Sano Keiji
Publication year - 2004
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20044
Subject(s) - medicine , hepatocellular carcinoma , liver transplantation , hepatectomy , surgery , mortality rate , survival rate , radiology , transplantation , resection
Abstract Due to the prevalence of hepatitis virus infection, the incidence of hepatocellular carcinoma (HCC) is very high in Japan. Many techniques have been devised by Japanese surgeons to reduce the mortality rate after hepatectomy for HCC: preoperative precise evaluation of hepatic functional reserve, portal venous embolization as preoperative preparation, anatomical and nonanatomical limited resections using intraoperative ultrasonography, and intermittent inflow occlusion during liver transection. Several challenging surgical procedures are also being tried for advanced HCC: HCC with portal and hepatic venous tumor thrombus, multiple and/or recurrent HCC, and HCC in the caudate lobe. As a result, the latest national survey of HCC revealed that operative mortality was 0.9% and the 5‐year survival rate after surgery was 52%. Living‐donor liver transplantation for adult patients with HCC is another surgical treatment developed in Japan. After the success of adult‐to‐adult living donor liver transplant using a left liver graft in 1993, a right liver graft, a left liver graft with caudate lobe, and a right lateral sector graft were developed. Indications for reconstructing the middle hepatic vein tributaries in right liver grafts were also proposed. Consequently, in our series of 36 patients with HCC who underwent living‐donor liver transplantation, operative mortality was 3%, and the 2‐year survival rate was 84%. (Liver Transpl 2004;10:S46–S52.)