title: Hepatocarcinoma: considerations on surgical treatment in a personal series of 23 patients.
abstract: OBJECTIVE
  Surgical treatment of primary liver tumors has undergone significant changes in recent years because of improved surgical and anesthesiological techniques and better pre- and post-operative care. We review our personal series from 1987-1995.
  
  
  METHODS
  Of 31 cases of hepatocellular carcinoma (HCC) observed in the years 1987-1995, 23 underwent curative resective surgery for a total of 24 liver resections: 6 hepatectomies; 10 segmentectomies; 4 atypical subsegmentectomies; 2 extended resections, with excision of neoplastic thrombi within the portal vein; 1 orthotopic liver transplantation in another institution, and 1 limited segmental resection for tumor recurrence. In 7 recent cases, pre-operative transcatheter arterial chemoembolization (TAE) was used.
  
  
  RESULTS
  The mean survival of the 13 patients that are known to be deceased is 27 months (range: 7-114 months). Perioperative mortality was nil. Actuarial 5-year survival rate is 27%. Pre-operative TAE was used in 7 patients: 4 out of 7 lesions were significantly reduced at computed tomography (CT) scan control 21 days following TAE, while in 3 the tumor size was unchanged.
  
  
  CONCLUSIONS
  Liver surgery, even major resections, has become safe with no perioperative mortality in our series. In our experience, pre-operative TAE has often produced significant reduction of the mass, but its real efficacy is still the subject of debate. TAE and percutaneous ethanol injection (PET) should be evaluated as part of combined multimodality treatment in the therapy of large lesions previously considered inoperable.
authors.affiliation: Universita degii Studi di Milano, Ospedale Luigi Sacco, Cattedra di Chirurgia Generale, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Taschieri
authors.forename: M
authors.initials: M
authors.lastname: Elli
authors.forename: M
authors.initials: M
authors.lastname: Cristaldi
authors.forename: M P
authors.initials: MP
authors.lastname: Rovati
authors.forename: P G
authors.initials: PG
authors.lastname: Danelli
authors.forename: A
authors.initials: A
authors.lastname: Vignati
authors.forename: G M
authors.initials: GM
authors.lastname: Sampietro
authors.forename: S
authors.initials: S
authors.lastname: Taschieri
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015996:Survival Rate