Hepatocellular carcinoma. Changing concepts in diagnosis and management.

We studied 86 cases of hepatocellular carcinoma treated between 1968 and 1982. All other liver tumors were excluded. There were 73 male and 13 female patients (average age, 59 years). The most frequent symptoms were pain (73%), weight loss (56%), and increased abdominal girth (23%). The alpha 1-fetoprotein level was elevated in 23 of 32 patients, and the hepatitis B surface antigen was positive in 15 of 36. Significant differences in the hematocrit reading and total bilirubin and total protein levels were found between those patients with resectable and unresectable tumors. Forty-six patients underwent laparotomy, with a resection rate of 48%. There were six right hepatic lobectomies, four left hepatic lobectomies, and 12 trisegmentectomies . The long-term survival in patients who underwent laparotomy and biopsy only was 4.2 months, while those who underwent resection had an average longevity of 18.7 months (the longest was 11.5 years). Using new imaging techniques, the extent of tumor involvement and operability can be determined with greater accuracy. Criteria for resectability include (1) the absence of vena caval occlusion, (2) the lack of spread between lobes, (3) the absence of portal vein obstruction, and (4) the lack of extrahepatic metastasis.