title: [A surgery oriented serial treatments of 191 patients with large primary liver cancer].
abstract: OBJECTIVE
  To discuss the methods and effects of a series of surgery oriented therapies in the treatment of large primary liver cancers.
  
  
  METHODS
  From January 1993 to June 1999, 191 patients with large liver cancer were treated chiefly by operation. The size of the primary cancer varied from 5.2 to 19.7 cm (median 9.4 cm). Various kinds of liver resections were performed in 121 patients and, as a supplement, deep cryosurgery was carried for out the rest 70 patients. Importable drug delivery system (IDDS) was instituted intraoperatively. Transcatheter arterial chemo-embolization (TACE, THP 30-60 mg, E-ADM 20-40 mg, CDDP 40-80 mg, MMC 10-20 mg, iodine oil 5-30 ml), percutaneous ethanol injection (PEI), bioimmunotherapy and the traditional Chinese medicine were used pre- and post-operatively. CT angiography (CTA) and CT during arterial portography (CTAP) were used to find satellite nodules. Early recurrence was diagnosed by AFPmRNA monitor in peripheral blood. Child's classification plus branch chain amino acid/aromatic amino acid (BCAA/AAA) were adopted in evaluating the pre-operative liver functions.
  
  
  RESULTS
  Remarkable results were observed after this surgery oriented serial treatment. The 1-, 3- and 5-year survival rates in the resection group were 75.8%, 45.6% and 30.4%, respectively. The 1- and 3-year survival rates in the cryosurgery group were 63.2% and 37.0%. The operative mortality was 1.6%. Recurrence rates were 69.2% in AFPmRNA positive group and 33.3% in AFPmRNA negative group. Comparing this two groups, significant difference was observed (P < 0.05). BCAA/AAA were lower than 1.5 in two patients died after resection.
  
  
  CONCLUSIONS
  A serial treatment with surgery as the chief modality gives satisfactory results in large primary liver cancers. This regimen should be adhered to as a main strategy in dealing with large liver cancers. AFPmRNA in the peripheral blood, signifying a recurrence, may become a hope of a new clinical parameter. BCAA/AAA plus Child's classification is able to evaluate more accurately the hepatic functional reserve before surgery.
authors.affiliation: Liver Cancer Institute, Post & Telecommunications General Hospital, Department of Hepatic Surgery, Eighth Clinical College, Beijing University, Beijing 100032, China.
authors.forename: J
authors.initials: J
authors.lastname: Rui
authors.forename: S
authors.initials: S
authors.lastname: Wang
authors.forename: S
authors.initials: S
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015996:Survival Rate