title: Is intraoperative adjuvant therapy effective for satellite lesions in patients undergoing reduction surgery for advanced hepatocellular carcinoma?
abstract: OBJECTIVE
  The effectiveness of intraoperative adjuvant therapy for satellite lesions of nonresectable hepatocellular carcinoma (HCC) was investigated.
  
  
  METHODS
  We randomly assigned 30 eligible patients with advanced-stage HCC with multiple intrahepatic lesions who underwent reduction hepatectomy in conjunction with either intraoperative adjuvant therapy (hepatectomy plus microwave coagulonecrotic therapy or radiofrequency ablation) or postoperative adjuvant therapy (transcatheter arterial embolization). The cumulative survival rates were obtained for both groups using the Kaplan-Meier method and compared using the log-rank test. To evaluate whether the intraoperative adjuvant therapy significantly influenced the prognosis, we reviewed changes in clinical factors by multiple regression analysis using the Cox's proportional hazard model. Ap value of less than 0.05 was considered statistically significant.
  
  
  RESULTS
  The 3- and 5-year cumulative survival rates in patients who underwent intraoperative adjuvant therapy were 35.7% and 7.7%, while those in patients who underwent postoperative adjuvant therapy were 35.0% and 0%, respectively. The difference was not statistically significant. The level of a-fetoprotein, maximum tumor size, number of tumors, and clinical stage were found to be independent factors affecting survival after diagnosis. Intraoperative adjuvant therapy was not an independent prognostic factor.
  
  
  CONCLUSIONS
  The survival rates did not differ between the patients who underwent intraoperative adjuvant therapy and postoperative adjuvant therapy for satellite lesions of non-resectable HCC.
authors.affiliation: First Department of Surgery, Nippon Medical School, Tokyo, Japan. Taniain@nms.ac.jp
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Taniai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mamada
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kawano
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Mizuguchi
authors.forename: Koho
authors.initials: K
authors.lastname: Akimaru
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D004564:Electrocoagulation; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008872:Microwaves; D008875:Middle Aged; D009367:Neoplasm Staging; D015996:Survival Rate