J.Jpn. Surg. Soc.. 99(4): 214-218, 1998

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Feature topic

TREATMENT OF HEPATOCELLULAR CARCINOMA：APPLICATION OF VASCULAR SURGERY

The present status of hepatic resection for hepatocellular carcinoma (HCC) is reviewed with special reference to the vascular aspects. Hepatic resection combined with portal tumor thrombectomy has been attempted in Japan. This procedure may be effective in the prevention of rupture of esophageal varices and making transcatheter arterial embolization possible. According to the report of Yamaoka and his associates, the 1- and 3-year survival rates of 29 patients treated with this combined procedure were 53％ and 12％, respectively. This surgical strategy may thus yield survival benefts.
In patients with a tumor near the confluence of the major hepatic vein and inferior vena cava, resection of segments 4b, 7, and 8 combined with hepatic vein reconstruction has been performed, which allows functional preservation of the residual liver.
The historical development of hepatic vascular exclusion (HVE) is also reviewed. HVE can be performed safely using a centrifugal active pump, even in patients with cirrhosis. Hepatic resection combined with removal of tumor thrombus in the right atrium has been carried out using extracorporeal circulation. There are reports that at least two patients undergoing this operation survived more than 2 years after surgery. The hepatic warm ischemic time should be less than 60 min.
Vascular surgery techniques are being increasingly applied in Japan for the treatment of HCC. Such surgery can be performed safely even in patients with cirrhosis. Improvement of long-term survival in patients undergoing such procedures remains an unresolved problem, however.

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