Objective: To discuss the methods and effects of serial therapies oriented by surgery in the treatment of primary large liver cancers.
Methods: From January 1993 to June 1999, 191 patients with large liver carcinoma were treated surgically. The size of tumors varied from 5.2 to 19.7 cm (mean 9.4 cm). Several types of liver resections were made in 121 patients and as a supplement, cryosurgery was carried out for the remaining 70 patients. Importable drug delivery system was instituted intraoperatively. Transcatheter arterial chemo-embolization (THP 30-60 mg, E-ADM 20-40 mg, CDDP 40-80 mg, MMC 10-20 mg, iodin oil 5-30 ml), percutaneous ethanol injection, bioimmunotherapy and traditional Chinese medicine were used pre- and post-operatively. CT angiography and CT during arterial portography were used to find satellite nodules. Early stage recurrences were predicted by AFPmRNA in peripheral blood. Child-Pugh’s classification plus branch chain amino acid/aromatic amino acid ratio (BCAA/AAA) was adopted in evaluating pre-operative liver functions.
Results: Marked results were observed after serial treatments oriented by surgery. The 1-, 3- and 5-year survival rates in resection group were 75.8%, 45.6% and 30.4%, respectively. The 1- and 3-year survival rates in cryosurgery group were 63.2% and 37.0%. The operative mortality was 1.57%. Recurrence rates were 69.2% in AFPmRNA positive group and 33.3% in AFPmRNA negative group (P<0.05). The BCAA/AAA ratio was lower than 1.5 in two patients who died of hepatic failure after resection.
Conclusions: Serial treatments with surgery as the chief modality gives satisfactory results in patients with large primary liver carcinoma. This regimen should be regarded as a main strategy to deal with large liver carcinoma. AFPmRNA in the peripheral blood, signifying a recurrence, may become a new clinical parameter. The BCAA/AAA ratio plus Child-Pugh’s classification is able to evaluate more accurately liver function reserve before surgery.