OBJECTIVETo study the micrometastasis distribution in liver tissue surrounding hepatocellular carcinoma (HCC), and provide reference for appropriate surgical safety margin.

METHODSThirty-six patients with HCC but without clinical metastasis underwent hepatectomy. Their specimens showing ample surgical margin were made into giant sections. Tumor micrometastasis in liver tissue around the primary tumor were examined microscopically. In each specimen, the surrounding tissue was divided into proximal(p) and distal(d) areas. In either area, three lines of demarcation 0.5 cm, 1.0 cm, and 2.0 cm away from the margin of the primary tumor were designated as L(0.5), L(1.0) and L(2.0). Therefore, the surrounding tissue was divided into six zones - Z(p0.5), Z(p1.0), Z(p2.0) and Z(d0.5), Z(d1.0), Z(d2.0). The maximum micrometastasis spread distance (MMSD) and density (D(p0.5), D(p1.0), D(p2.0) and D(d0.5), D(d1.0), D(d2.0)) in each zone were analyzed after search for micrometastasis in the giant sections.

RESULTS72.5% (111/153) micrometastases were found in form of microscopic tumor emboli. Their spread distance could be up to 6.1 cm. In 66.7% (24/36) specimens, micrometastases were found in the surrounding tissue. In 91.7% (22/24) of them, the distal MMSD was less than 3 cm. The proximal MMSD was less than 1.5 cm in 92.3% (12/13). The comparison of micrometastasis density in the different zones were D(d0.5) > D(d1.0) > D(d 2.0); D(p0.5) > D(p1.0) > D(p2.0); D(d1.0) > D(p1.0); D(d2.0) > D(p2.0) with significant differences.

CONCLUSION(1) Micrometastases of HCC exist mainly in form of microscopic tumor emboli, (2) The longer the distance from the primary focus, the lower the micrometastasis incidence, (3) In zones more than 0.5 cm away from the primary focus, tumor micrometastasis incidence is significantly lower in the proximal zones than that in the distal zones and (4) For HCC patients without clinical metastasis, a surgical margin of 3 cm wide in the distal area and 1.5 cm wide in the proximal area may reduce the rate of postoperative recurrence.

Carcinoma, Hepatocellular ; secondary ; surgery ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; pathology ; surgery ; Neoplasm Metastasis ; Neoplasm Recurrence, Local

OBJECTIVE: To explore the technique and effect of liver hanging maneuver in anterior approach for isolated complete liver caudate lobectomy. METHODS: We recruited 17 patients with liver caudate lobe tumor (13 primary hepatocellular carcinoma, 3 cholangiocarcinoma and 1 liver metastasis from colorectal cancer). Isolated complete caudate lobectomy with liver hanging maneuver was performed in 17 patients. RESULTS: All 17 patients were successfully received the above-mentioned operation. The operative time was 166-427 (211.5 ± 20.1) min and the intraoperative blood loss was 372-1 208 (472.7 ± 83.6) mL. There was no operative death. The survival rates of follow up for 1, 3 and 5 years were 76.5%, 52.9% and 23.5%, respectively. CONCLUSION Liver hanging maneuver for isolated complete resection of the caudate lobe is an ideal approach for liver neoplasms resection.
Blood Loss, Surgical ; Carcinoma, Hepatocellular ; surgery ; Cholangiocarcinoma ; surgery ; Colorectal Neoplasms ; pathology ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; secondary ; surgery ; Survival Rate

OBJECTIVETo evaluate the effectiveness of a tailored approach to radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC).

METHODSUltrasound-guided percutaneous RFA was performed in 274 tumors of 228 patients located at liver periphery, including 59 near the bowel, 115 near the diaphragm, 54 near the gallbladder, and 46 near the liver surface. The tumor sizes ranged 1.2-7.0 cm [mean (3.7 +/- 1.2) cm]. A tailored treatment strategy was established for tumors in different locations. Contrast-enhanced CT was performed one month later to evaluate the early necrosis rate of the treated tumors.

RESULTSEarly tumor necrosis rate was 91.6% of the peripherally located HCC, including 91.5% of the tumors near the bowel, 90.4% near the diaphragm, 92.6% near the gallbladder, and 93.5% near the liver surface. Local tumor recurrence rates were 8.5%, 9.6%, 7.4%, and 6.5% for tumors near the bowel, diaphragm, gallbladder, and liver surface, respectively. The 1-, 2-, and 3-year survival rate of this group were 82.3%, 62.9%, and 53.7%, respectively. Major complications occurred in 3.3% of the treatment sessions, including haemorrhage (n = 2), nearby structure injury (n = 6), and needle tract seeding (n = 4).

CONCLUSIONThe tailored approach to RFA provides a promising treatment option for refractory peripherally located HCC with satisfactory tumor necrosis rate and low complication rate.

Abdominal Neoplasms ; secondary ; surgery ; Carcinoma, Hepatocellular ; secondary ; surgery ; Catheter Ablation ; adverse effects ; Humans ; Liver Neoplasms ; pathology ; surgery ; Neoplasm Recurrence, Local ; Treatment Outcome

Adenocarcinoma ; metabolism ; secondary ; surgery ; Carcinoembryonic Antigen ; metabolism ; Carcinoma, Hepatocellular ; metabolism ; secondary ; surgery ; Colectomy ; Colonic Neoplasms ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Humans ; Keratin-18 ; metabolism ; Liver Neoplasms ; metabolism ; secondary ; surgery ; Male ; Middle Aged ; alpha-Fetoproteins ; metabolism

Although the adrenal gland is a common site of metastasis from hepatocellular carcinoma (HCC), adrenal metastases are rarely seen in clinical practice because of its lower metastatic potential compared to the other malignancies. Adrenal metastases usually were detected at the time of diagnosis of primary HCC or simultaneously with intrahepatic recurrence after curative management of HCC. It is very rare that only metastatic HCC is detected without evidence of intrahepatic recurrence. Hereby, we report two cases of adrenal metastasis from HCC without intrahepatic recurrence after hepatic resection.
Adrenal Gland Neoplasms/*diagnosis/radionuclide imaging/secondary ; Aged, 80 and over ; Carcinoma, Hepatocellular/*pathology/surgery ; Humans ; Liver Neoplasms/*pathology/surgery ; Male ; Positron-Emission Tomography ; Tomography, X-Ray Computed

A 28-year-old female with a pregnant state of 29th gestational week was admitted because of nausea and vomiting. MRI showed a huge hepatocellular carcinoma. At the 36th gestational week, a normal delivery was done. Surgery of hepatocellular carcinoma was done at 20 days after delivery. After 22 months from the operation, pulmonary metastasis was found and resection of lung mass was done. About 3 years after resection, a low attenuating nodule was detected in the left atrial chamber of heart. We report a case of hepatocellular carcinoma with metastatic lesions to lung and heart in a pregnant woman.
Adult ; Carcinoma, Hepatocellular/diagnosis/*secondary/surgery ; Female ; Heart Atria ; Heart Neoplasms/diagnosis/*secondary ; Humans ; Infant, Newborn ; Liver Neoplasms/diagnosis/*pathology/surgery ; Lung Neoplasms/diagnosis/secondary ; Pregnancy ; *Pregnancy Complications, Neoplastic/diagnosis

BACKGROUND/AIMS: Although the lung is the most common site of extrahepatic spread from hepatocellular carcinoma (HCC), the role of surgery for pulmonary metastasis remains unclear. The aim of this study was to evaluate the efficacy of pulmonary resection in patients with pulmonary metastasis from HCC. METHODS: Between July 2000 and July 2004, a total of 6 patients with pulmonary metastasis from HCC underwent curative pulmonary resections. The patients were divided into two groups (Surgery group and Non-surgery group) according to the primary treatment modality of HCC. Medical records, imaging studies, and pathologic reports of the surgical specimens were reviewed. RESULTS: Three patients in the surgery group underwent pulmonary resections for a solitary metastasis after hepatectomy for HCC, and they are all still alive. One of the 3 patients developed a tumor recurrence in the chest wall after pulmonary resection. The survival time after diagnosis of HCC were 79, 122, and 54 months, respectively. The survival time after pulmonary metastatectomy were 49, 39, and 20 months in the three patients. Another 3 patients in the non-surgery group, received a pulmonary metastatectomy; they had either a complete response HCC or partial radiologic response. These 3 patients developed recurrent disease in the liver. One of 3 patients died. The survival time after diagnosis of HCC were 153, 83, 12 months. The survival time after pulmonary metastatectomy were 51, 4, 2 months. CONCLUSIONS: The surgical resections of a solitary pulmonary metastasis from HCC in highly selected patients might be an effective treatment modalities for prolonged survival.
Adult ; Carcinoma, Hepatocellular/diagnosis/mortality/*secondary/*surgery ; Humans ; Liver Neoplasms/*pathology ; Lung Neoplasms/diagnosis/mortality/*secondary/*surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; *Pneumonectomy/mortality ; Survival Rate ; Treatment Outcome

No abstract available.
Carcinoma, Hepatocellular/*pathology/secondary/surgery ; Diagnosis, Differential ; Hepatitis B, Chronic/diagnosis ; Humans ; Liver Neoplasms/diagnosis/*pathology/surgery ; Male ; Middle Aged ; Sarcoma/diagnosis/*pathology/surgery ; Tomography, X-Ray Computed ; Vimentin/metabolism

INTRODUCTIONPatients with peritoneal metastases (PM) from hepatocellular carcinoma (HCC) often experience a rapid demise even after a complete removal of intrahepatic tumour. Localised PM may now be adequately controlled and managed with cytoreductive surgery (CRS).

TREATMENTThree patients underwent CRS for HCC PM.

OUTCOMEThe first patient survived 21 months from the time of CRS and is alive with the disease. The second patient died 4 months after CRS. The third patient survived 10 months since CRS and is also alive with the disease. Collectively, the survival of 24 patients with HCC PM extracted through a collective literature review who were treated with cytoreductive surgery had 1- and 2-year survival percentages of 83% and 71%, respectively.

CONCLUSIONCareful selection of patients with localised disease to the peritoneal cavity for CRS, taking into consideration the performance status, liver function and tumour biology may lead to a successful outcome in patients with HCC PM.

Carcinoma, Hepatocellular ; drug therapy ; pathology ; surgery ; Fatal Outcome ; Female ; Humans ; Liver Neoplasms ; drug therapy ; pathology ; surgery ; Male ; Middle Aged ; Peritoneal Neoplasms ; drug therapy ; secondary ; surgery ; Peritoneum ; pathology ; Young Adult

No abstract available.
Carcinoma, Hepatocellular/*pathology/surgery ; Catheter Ablation ; Colonic Neoplasms/*diagnosis/pathology/*secondary ; Colonoscopy ; Humans ; Liver Neoplasms/*pathology/surgery ; Male ; Middle Aged ; Positron-Emission Tomography ; Tomography, X-Ray Computed ; Whole Body Imaging