title: Volume reduction surgery for advanced hepatocellular carcinoma.
abstract: OBJECTIVE
  The aim of this study was to evaluate the prognostic impact of reductive surgery on the survival of patients with advanced hepatocellular carcinoma (HCC).
  
  
  METHODS
  Eligible patients had a main tumor greater than 10 cm in diameter with multiple intrahepatic metastases (>5 nodules), and good liver function (Child-Pugh class A), but no tumor thrombus in the main portal vein. The main tumor was surgically removed but the metastases were not removed and were treated with repeated transcatheter hepatic arterial chemo-embolization (TAE).
  
  
  RESULTS
  From Jun 1997 to May 2003, 13 patients (median age 61 years, range: 48-74) were prospectively enrolled. The median diameter of the main tumor was 14 cm (range 11.5-18.0). No major surgical complications were observed and the median hospital stay was 12 days (range 7-20). The first TAE was performed 1 month after hepatectomy in all patients and was repeated for median of 5 (range: 1 to 16) times. Complete remission was observed in two patients. One patient had recurrence afterwards but another patient survived 41 months without recurrence. Three patients survived more than 3 years. The overall 1-, 3-, and 4-year survival rates of the 13 patients were 67.7%, 40.6%, and 40.6%, respectively.
  
  
  CONCLUSIONS
  Volume reduction surgery followed by TAE might prolong the survival of patients with a large HCC and intrahepatic metastases, especially those with a main tumor on the right side.
authors.affiliation: Hepatobiliary Pancreatic Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha Kashiwa, 277-8577 Chiba, Japan. kazinoue-tky@umin.ac.jp
authors.forename: Kazuto
authors.initials: K
authors.lastname: Inoue
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nakamura
authors.forename: Taira
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Masaru
authors.initials: M
authors.lastname: Konishi
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakagohri
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Oda
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Takahashi
authors.forename: Naoto
authors.initials: N
authors.lastname: Gotohda
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hayashi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nawano
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome