Comprehensive treatment of liver cancer

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Comprehensive treatment of liver cancerDepartment of liver surgery, Chinese Academy of Medical SciencesWith the rapid development of modern

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Comprehensive treatment of liver cancer

Department of liver surgery, Chinese Academy of Medical Sciences

With the rapid development of modern science and technology, a number of new treatment techniques have emerged, which have been widely used in clinical practice. These technologies include: interventional therapy, radiofrequency ablation, X knife treatment, cryotherapy, microwave treatment, ethanol (alcohol) intratumoral injection therapy, etc.. How to choose a reasonable treatment for patients with primary liver cancer, there is no uniform reference standards. The sixth national academic meeting of the Preparatory Committee of the drafting of liver surgery on the surgical treatment of primary hepatocellular carcinoma methods "of the draft, through discussions by the group of experts of the Chinese branch of surgery after liver surgery. The full text of the scheme is as follows: as a reference for the treatment of primary liver cancer in the future, we should choose the treatment method. Department of hepatobiliary, pancreatic and splenic surgery, Beijing Chaoyang Hospital, Jin Zhongkui

Surgical indications of hepatectomy for primary liver cancer

First, the general situation of patients

1 patients were generally better, no obvious heart, lung, kidney and other important organ organic lesions.

2 normal liver function, or only mild damage, according to the classification of liver function is grade I; or the grade of liver function is 2 level, the short-term liver improved significantly after treatment, liver function recovered to grade I.

3 liver reserve function (e.g. ICG, R15) normal range.

4 without extensive extrahepatic metastatic liver cancer.

Two, local lesions

(a) the following cases may be treated with radical hepatectomy

1 single small hepatocellular carcinoma (less than 2cm).

2 single small hepatocellular carcinoma (diameter, 2cm, 5cm).

3 solitary large HCC growth from the liver (the diameter more than 5cm, less than 10cm) or large hepatocellular carcinoma (diameter > 10cm.), the surface is smooth, the surrounding boundaries more clearly, by the liver tumor destruction is less than 30%.

More than 4 hepatocellular carcinoma, cancer nodules less than 3, and the limitations in the liver of a leaf or in.

(two) only palliative liver resection is available in the following cases:

1 3-5 of multiple tumors, beyond the range of half liver, as multiple localized resection; or liver cancer confined to the adjacent 2-3 liver sections or semi liver imaging showed no tumor side of liver tissue obviously compensatory increase, up to more than 50% of the whole liver.

2 the left or right lobe liver large hepatocellular carcinoma or large hepatocellular carcinoma, with clear border, the first and the two hepatic portal inviolacy; imaging showed the tumor free liver side obvious compensatory increase, more than 50% of total liver tissue.

The 3 is located in the central part of the liver (liver lobe, or IV and V, VIII) large hepatocellular carcinoma, tumor free liver tissue was compensatory increase, up to more than 50% of the whole liver.

The 4 section I or large hepatocellular carcinoma or large hepatocellular carcinoma.

5 hilar lymph node metastasis, such as primary liver cancer can be removed, should be tumor resection, at the same time for hilar lymph node dissection.

6 peripheral organs (colon, stomach, septum or right adrenal gland), such as primary liver tumor resection, should be combined with the tumor and the invasion of organs resection. Distant metastasis of single organ metastasis, such as solitary lung metastasis, can be performed simultaneously with primary liver cancer resection and metastasis.

Surgical indications of primary hepatocellular carcinoma with portal vein tumor thrombus and / or vena cava tumor thrombus

First, the general situation of patients

Liver resection.

Two, local conditions

1 according to the criteria of liver resection for primary liver cancer, the tumor was resectable.

2 cancer thrombus is filled with the main branch of the portal vein or the trunk of the 8 and further development, will soon endanger the lives of patients.

3 it is estimated that the formation time of the tumor thrombus is short, and it has not happened yet. The above cases are suitable for the treatment of portal vein resection and embolectomy.

4 if the cancer embolus in liver at or above the level of small portal vein in liver resection at the same time, along with the section of the branch of portal vein resection for hepatectomy, can open the portal vein stump thrombectomy, not necessary to cut open vein thrombectomy.

5 if the operation can not be found in the tumor resection, incision in portal vein thrombectomy after surgery, intraoperative selective hepatic artery chemoembolization and portal vein chemotherapy, cryotherapy or radiofrequency treatment etc..

6 with venous tumor thrombus, in total hepatic vascular occlusion, cut open venous thrombectomy, and resection of hepatocellular carcinoma.

Surgical indications of primary hepatocellular carcinoma with bile duct tumor thrombus

First, the general situation of patients

Basic requirements with hepatectomy. It should be noted that patients with obstructive jaundice, liver function classification should be emphasized in patients with systemic conditions, A/G ratio and prothrombin time.

Two, local conditions

1 according to the criteria of liver resection for primary liver cancer, the tumor was resectable.

2 the tumor thrombus was located in the left hepatic duct or right hepatic duct, common hepatic duct and common bile duct.

3 it is estimated that the formation time of the tumor thrombus is short, and it has not happened yet.

4 the tumor thrombus was not invaded and the bile duct was more than 2.

All the cases were treated with bile duct incision and embolectomy.

5 if the tumor thrombus is located in the small branch of the hepatic duct above the hepatic segment, it can be resected with the branch of the hepatic duct while the liver cancer is resected.

6 found in the operation of cancer can not be removed, can be opened in the common bile duct embolectomy, selective hepatic artery catheterization chemotherapy, cryotherapy or radio frequency treatment.

Case selection of radiofrequency, cryotherapy and microwave therapy

First, the general situation of patients

1 the general situation of the patients is better, there is no obvious heart, lung, kidney and other important organs of the organic lesions, functional status, or only mild damage.

2 normal liver function, or only mild damage, according to the classification of liver function is level 1 or level 2.

Two, local conditions

1 single cancer, or cancer in less than 5; tumor diameter less than 5 cm.

2 patients with recurrent HCC after hepatectomy are unsuitable or unwilling to undergo re hepatectomy.

These can be treated by ultrasound guided percutaneous liver puncture, can also be used in the operation; the technology for treatment of hepatic cutting surface in hepatectomy, the wound can not only eliminate residual cancer cells, but also help the hemostasia effect and increase the safety of surgery.

A case study of ethanol injection (ethanol) in the diagnosis of cancer

First, the general situation of patients

1 the general situation of the patient is better, no obvious heart, lung, kidney and other important organs organic lesions; or heart, lung, kidney and other organs have organic pathological changes, function is not good.

2 liver function has obvious damage, not suitable for liver resection.

Two, local conditions

1 single or multiple nodular tumors, but not more than 5.

2 patients with recurrent HCC after hepatectomy are unsuitable or unwilling to undergo re hepatectomy.

Surgical indications of primary hepatocellular carcinoma with portal hypertension

First, the general situation of patients

1 patients were generally better, no obvious heart, lung, kidney and other important organ organic lesions.

2 normal liver function, or only mild damage, according to the classification of liver function is a grade I or II; liver function, the short-term liver improved significantly after treatment, liver function recovered to grade I.

3 liver reserve function (such as ICG, R15) within the normal range.

4 non metastatic liver cancer.

Two, local conditions

1 resectable hepatocellular carcinoma: (1) there are obvious splenomegaly and hypersplenism (WBC less than 3 * 109/L, platelet lower than 50 * 109/L) performance, at the same time as the splenectomy. (2) there are obvious esophageal and gastric varices, especially had variceal bleeding can be considered at the same time, pericardial devascularization; severe gastric mucosal lesions, such as allowing patients, should be selective portacaval shunt for splenorenal shunt or other types of.

Found that 2 were unresectable hepatocellular carcinoma: (1) there are obvious splenomegaly and hypersplenism (WBC less than 3 * 109/L, platelet lower than 50 * 109/L) showed no significant esophageal and gastric varices, splenectomy and selective hepatic artery embolization chemotherapy, cryotherapy or radiofrequency treatment in operation. (2) there are obvious esophageal and gastric varices, especially had variceal bleeding, no severe gastric mucosal lesions, or for splenectomy, splenic artery ligation plus coronary vein ligation; whether devascularization, according to the decision of. Then, during the operation, the patients were treated with radiofrequency or cryotherapy.

Annex I

Recommendations for case selection of transcatheter arterial chemoembolization (HACE)

First, the general situation of patients

1 the general situation of patients is better, no obvious heart, lung, kidney and other important organs of the organic lesions, functional status.

2 liver function was normal, or only mild damage, according to the classification of liver function class I or ii.

Two, local conditions

1 of the tumors were multiple and scattered in the liver.

2 the tumor was larger, but no compensatory enlargement was found in the liver without tumor. The volume was less than 50% of the whole liver.

3 although the tumor is small, but there is a serious liver cirrhosis, liver volume significantly reduced.

4 there was no tumor thrombus in the portal vein of the contralateral liver, but there was a tumor thrombus in the portal vein.

5 there was no tumor thrombus in the intrahepatic bile duct and extrahepatic bile duct.

6 the recurrence of liver cancer after liver resection is not appropriate or the patient is not willing to re operation.

In principle, resectable hepatocellular carcinoma is not treated with radiotherapy before operation.

Annex two

Recommendations for the selection of X knife treatment techniques

First, the general situation of patients

1 the general situation of the patients is better, there is no obvious heart, lung, kidney and other important organs of the organic lesions, functional condition is good; or heart, lung, kidney and other important organs have organic pathological changes, function is not good.

2 liver function has obvious damage, not suitable for liver resection.

3 no obvious splenomegaly and hypersplenism (WBC less than 3 * 109/L, platelet lower than 50 * 109/L) clinical manifestations.

Two, local conditions

1 single liver cancer foci with a diameter of 3cm.

2 small recurrent tumor recurrence after resection of the liver is not appropriate or the patient is unwilling to undergo a re hepatectomy.

 

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