[Recent advances in surgical therapy of hepatocarcinomas. 5 questions on the exeresis of carcinomas of the cirrhotic liver].
The surgical treatment of cancers in cirrhotic liver has two main objectives: 1) to remove the cancer with low mortality and mobility rate; 2) to carry out a radical operation with a survival index of 50% three years after the operation. For this purpose, five queries may contribute to programming the most suitable surgery. 1) What patients can be operated? a) those without abdominal ascitic effusion; b) anicteric patients; c) those with fairly well preserved liver function. 2) What liver cancers can be resected? Mainly those with a single localisation. 3) What investigations offer a picture of the extent of tumoral invasion? a) ultrasonography; b) arteriography with simultaneous injection of Lipiodol and later echography; c) intraoperative echography. 4) What surgical operation should be carried out? Liver resection as "economical" as possible (cirrhotic liver) but at the same time as "radical" as possible (hepatocarcinoma). 5) What results can be expected? a) 5% mortality; b) 30% survival 3 years after operation. As the prognosis of liver cancers in cirrhotic livers is better the more limited are the dimensions of the tumour at the time of operation, only systematic screening of cirrhotic patients by repeated ultrasonography permits their treatment at an earlier stage.
Belghiti
J
J
Carditello
A
A
D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery*
Recenti progressi nella terapia chirurgica degli epatocarcinomi. Cinque quesiti sulla exeresi dei carcinomi su fegato cirrotico.