Purpose: 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.