title: Long-term results of hepatic resection combined with intraoperative local ablation therapy for patients with multinodular hepatocellular carcinomas.
abstract: BACKGROUND
  Recently, local ablation therapy has been widely used for treatment of small hepatocellular carcinoma (HCC). The present study assessed the outcome of hepatic resection combined with intraoperative local ablation therapy in patients with multinodular HCCs.
  
  
  METHODS
  Forty-one patients with initial and multinodular HCCs underwent hepatic resection combined with intraoperative local ablation therapy. The mean maximum diameter of all tumors was 3.8 cm (range 2.1-16.0 cm), and the mean number of nodules was 3.2 (range 2-11). We evaluated the survival rates and assessed the prognostic factors associated with overall survival rates using Cox proportional hazard models.
  
  
  RESULTS
  Intraoperative local ablation therapy was completed in all patients with no evidence of residual viable tumor on the first postoperative computed tomography (CT) scan. The 3-, 5- and 7-year overall survival rates were 84.3%, 61.2%, and 61.2%, respectively. Patients with preoperative des-gamma carboxyprothrombin (DCP) level >300 mAU/ml showed significantly worse overall survival than those with DCP level <or=300 mAU/ml (P < 0.01).
  
  
  CONCLUSIONS
  Hepatic resection combined with intraoperative local ablation therapy is effective for multinodular HCCs. DCP >300 mAU/ml was a significant prognostic factor of long-term overall survival.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. itoshin@surg2.med.kyushu-u.ac.jp
authors.forename: Shinji
authors.initials: S
authors.lastname: Itoh
authors.forename: Kazutoyo
authors.initials: K
authors.lastname: Morita
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ueda
authors.forename: Keishi
authors.initials: K
authors.lastname: Sugimachi
authors.forename: Yo-ichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Gion
authors.forename: Kengo
authors.initials: K
authors.lastname: Fukuzawa
authors.forename: Kenzo
authors.initials: K
authors.lastname: Wakasugi
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome