Current management of hepatic tumors.

Today, the presence of a hepatic tumor can be diagnosed with considerable accuracy by means of isotope scans, arteriogram and ultrasonic imaging. Its localization to one lobe or other lobes is also generally achievable but with less accuracy because it is not yet possible to visualize the interlobar fissure by a noninvasive technique. Exploratory laparotomy with a view to resection is the preferred approach if the patient is in good general condition. Percutaneous biopsy of a hepatic lesion should be avoided unless laparotomy is not contemplated. Resection is the mainstay of therapy for all forms of hepatic malignant tumors and is the only modality that gives some prospect of cure. The prohibitively high operative mortality rate of former years, mostly due to hemorrhage, has gradually decreased with improved understanding of hepatic anatomy and innovations in surgical technique. By means of adequate vascular control and, if necessary, parenchymal cold perfusion, major resections of difficult and bulky lesions can now be accomplished with safety. Systemic chemotherapy with single agents, intra-arterial infusion chemotherapy and hepatic dearterialization have each been found to be of modest therapeutic value in a variable proportion of patients with diffuse unresectable cancer of the liver. The results of current experience indicate that the response rate is not high and long term control of tumor is rare. Multiple drug combinations with or without infusion therapy or dearterialization are being tried in many centers. Therapeutic strategy and end results for the different forms of benign and malignant neoplasms of the liver are discussed.