Surgical treatment of hepatocellular carcinoma: A rational strategy based on therapeutic outcome

Establishment of the first entry therapy of hepatocellular carcinoma (HCC) requires a prospective randomized control study. However, these are some of the medical moral considerations that we must take into account. Hence, it is necessary a comparison between the therapeutic outcome of HCC patients among independent surgical and medical institutes of the same geographic region. We investigated the comparative cumulative survival outcomes evaluating retrospectively 107 HCC patients who underwent hepatic resection in our institute and 158 patients who underwent minimally invasive non-surgical treatments in the 3rd Department of Internal Medicine. Tohoku University School of Medicine since 1973, according to numbers of tumors, diameter of the main tumor and their clinical stages. The latter treatment consisted mainly of transcatheter arterial embolization therapy (TAE) and percutaneous ethanol injection therapy (PEI). Five-year survival rate in the hepatic resection group, with mean tumor diameter measuring up to 3.0cm and number of tumors less than three was 57.8%, that with solitary tumor diameter between 3.1 and 5.0cm was 53.7% and that with mean tumor diameter over 5.1cm was 37.0%. Even though the outcome of non-surgical treatments for HCCs has been gradually improving, these investigations revealed appreciably better results for the surgical approach compared to non-surgical minimally invasive therapy. For the HCC patients who have good liver function, the systematic and anatomical surgical hepatic resection results in more favorable long-term outcome with a superiority of the local curability than non-surgical treatments. Therefore, surgical resection should be considered the first entry therapy and represent the gold standard strategy for HCC therapy.