Indications for Palliative Reduction Surgery in Advanced Hepatocellular Carcinoma

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Abstract
Objectives: To clarify the indications for and the significance of palliative reduction surgery in the multidisciplinary treatment of advanced hepatocellular carcinoma (HCC) and to propose the use of a remnant tumor index (RTI) as a simplified criterion for palliative reduction surgery in cases of advanced HCC. Design: A comparison of survival based on the RTI. Setting: A large university hospital in Japan. Patients: Twenty-five patients with advanced HCC who underwent palliative reduction surgery were divided into 3 groups as follows: group 1 (n=9), the remnant tumor after operation existed only in the liver and the RTI was less than 5.0; group 2 (n=11), the remnant tumor after operation existed only in the liver and the RTI was greater than 5.0; and group 3 (n=5), extrahepatic metastatic tumor existed after operation. Main Outcome Measures: Pathological findings and survival rate after surgery. Results: There was no significant difference in the degree of macroscopic intrahepatic metastases among the 3 groups; however, both the portal vein invasion and the histological grade tended to be more severe in groups 2 and 3. The respective 1-year and 3-year survival rates for group 1 were 67% and 33%, and those for group 2 were 21% and 0%. There were no survivors in group 3 at 1 year after surgery. Significant differences were found in the survival rates between groups 1 and 2 (P<.05), and between groups 1 and 3 (P<.05). Conclusion: Palliative reduction surgery for advanced HCC is only considered effective for patients with both an RTI of less than 5.0 and no extrahepatic metastasis. Arch Surg. 1997;132:120-123