Progress in surgical treatment of hepatocellular carcinoma.

Surgery for hepatocellular carcinoma has improved dramatically during the last two decades, and the improvement is mainly attributable to the development of intraoperative ultrasound-guided operative procedures such as Makuuchi's segmentectomy, introduction of the intermittent vascular occlusion technique, and establishment of the precise criteria for indications of various hepatectomy procedures. The use of preoperative portal vein embolization for inducing compensatory hypertrophy of remnant liver in the future has increased the safety and extended indications of hepatectomy for hepatocellular carcinoma. Operative mortality has fallen below 2% in the 1990s, with the 5-year survival rate reaching nearly 50% in a recent nationwide survey in Japan. More than 90% of hepatectomies at our institution are performed without red blood cell transfusions, and the mean hospital stay is shortened to approximately 23 days. Moreover, not a single case of operative death has been recorded since 1993.