BACKGROUND: Hepatocellular carcinoma is one of the most common tumors worldwide. Surgical resection has been the standard treatment but can only be applied to a small percentage of patients. In recent years, several other treatment options, including ablative procedures and transplantation, have been used in patients with hepatocellular carcinoma. METHODS: For 6 years, 110 patients with hepatocellular carcinoma were managed at the Medical College of Wisconsin. Fifty-five patients received only chemotherapy (n = 5) or palliative treatment (n = 50) because of advanced cirrhosis (P <.03) or tumor. Thirty-one patients had tumor ablation with percutaneous ethanol injection, cryoablation, radiofrequency ablation, or arterial chemoembolization. Twenty-eight patients underwent surgical resection (n = 18) or hepatic transplantation (n = 10). Relatively more patients (38%; P <.001) were treated with ablation in the second period of the study (1998-2000). RESULTS: Thirty-day mortality was 3% with ablation and 0% with resection. Median survival was 6 months with no treatment, 27 months with ablation (P <.001), and 35 months with resection (P <.001). Patients who underwent liver transplantation had the longest median survival (53 months). A multivariate analysis suggested that treatment modality (ablation or resection; P <.001) and Child-Pugh classification (P <.01) were the most important factors predicting outcome. CONCLUSIONS: This study suggests that treatment of hepatocellular carcinoma requires multidisciplinary expertise and that ablation and operation can be performed safely. Outcome is influenced most by treatment modality and Child-Pugh classification. Patients in Child-Pugh classes A and B should be treated with ablation, surgical resection, or liver transplantation.
BACKGROUND:Hepatocellular carcinoma is one of the most common tumors worldwide. Surgical resection has been the standard treatment but can only be applied to a small percentage of patients. In recent years, several other treatment options, including ablative procedures and transplantation, have been used in patients with hepatocellular carcinoma. METHODS: For 6 years, 110 patients with hepatocellular carcinoma were managed at the Medical College of Wisconsin. Fifty-five patients received only chemotherapy (n = 5) or palliative treatment (n = 50) because of advanced cirrhosis (P <.03) or tumor. Thirty-one patients had tumor ablation with percutaneous ethanol injection, cryoablation, radiofrequency ablation, or arterial chemoembolization. Twenty-eight patients underwent surgical resection (n = 18) or hepatic transplantation (n = 10). Relatively more patients (38%; P <.001) were treated with ablation in the second period of the study (1998-2000). RESULTS: Thirty-day mortality was 3% with ablation and 0% with resection. Median survival was 6 months with no treatment, 27 months with ablation (P <.001), and 35 months with resection (P <.001). Patients who underwent liver transplantation had the longest median survival (53 months). A multivariate analysis suggested that treatment modality (ablation or resection; P <.001) and Child-Pugh classification (P <.01) were the most important factors predicting outcome. CONCLUSIONS: This study suggests that treatment of hepatocellular carcinoma requires multidisciplinary expertise and that ablation and operation can be performed safely. Outcome is influenced most by treatment modality and Child-Pugh classification. Patients in Child-Pugh classes A and B should be treated with ablation, surgical resection, or liver transplantation.
Authors: C Angonese; A Baldan; U Cillo; A D'Alessandro; M De Antoni; M De Giorgio; A Masotto; D Marino; M Massani; M Mazzucco; E Miola; D Neri; D Paccagnella; G Pivetta; L Tommasi; F Tremolada; A Tufano; G Zanus; F Farinati Journal: Gut Date: 2006-03 Impact factor: 23.059
Authors: Georgios C Sotiropoulos; Nina Drühe; George Sgourakis; Ernesto P Molmenti; Susanne Beckebaum; Hideo A Baba; Gerald Antoch; Philip Hilgard; Arnold Radtke; Fuat H Saner; Silvio Nadalin; Andreas Paul; Massimo Malagó; Christoph E Broelsch; Hauke Lang Journal: Dig Dis Sci Date: 2008-12-05 Impact factor: 3.199
Authors: Krit Kitisin; Vignesh Packiam; Jennifer Steel; Abhinav Humar; T Clark Gamblin; David A Geller; J Wallis Marsh; Allan Tsung Journal: HPB (Oxford) Date: 2011-08-11 Impact factor: 3.647
Authors: Thilo Schäfer; Jens Sperling; Otto Kollmar; Sven Richter; Martin K Schilling; Michael D Menger; Werner Lindemann Journal: Int J Colorectal Dis Date: 2009-11-04 Impact factor: 2.571
Authors: R Santambrogio; M Podda; M Zuin; E Bertolini; S Bruno; G P Cornalba; M Costa; M Montorsi Journal: Surg Endosc Date: 2003-06-17 Impact factor: 4.584