[The significance of hepatic lobectomy as the surgical treatment for primary hepatocellular carcinoma].

Since most patients with primary hepatocellular carcinoma (HCC) in Japan have cirrhosis, indication of hepatectomy is now tending to be limited to a single segment or subsegment for small HCC. However, pathologic examinations on the resected specimens have revealed that intrahepatic metastases were associated in more than 50% of HCC smaller than 5 cm, indicating that hepatic resection is required in these patients to be as extensive as possible within the limit of hepatic reserve. Our multiple regression equation provided for the preoperative prediction of an early prognosis of hepatectomized patient has successfully reduced the incidence of postoperative fatal liver failure from 17% before 1980 to 6% after 1981. The sequential volumetric CT measurements of the remaining liver after hepatectomy in humans has revealed an ability of the cirrhotic liver to regenerate nearly as normal liver in patient who has well tolerated hepatic resection. Ligation or embolization of the portal vein of an affected side in patients with unresectable HCC has rapidly induced a compensatory hypertrophy in the contralateral lobe to be remained, indicating the potential usefulness of this procedure to relatively reduce the loss of functioning liver mass by the proposed lobectomy.