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The Use of a Remnant Tumor Index

Kazuharu Yamamoto, MD; Kenji Takenaka, MD; Naoyuki Kawahara, MD; Mitsuo Shimada, MD; Ken Shirabe, MD; Hidetoshi Itasaka, MD; Takashi Nishizaki, MD; Katsuhiko Yanaga, MD; Keizo Sugimachi, MD

Arch Surg. 1997;132(2):120-123.

Abstract
Objectives
To clarify the indications for and the significance of palliative reduction surgery in the multidisciplinary treatment of advanced hepatocellular carcinoma (HCC) and to propose the use of a remnant tumor index (RTI) as a simplified criterion for palliative reduction surgery in cases of advanced HCC.

Design
A comparison of survival based on the RTI.

Setting
A large university hospital in Japan.

Patients
Twenty-five patients with advanced HCC who underwent palliative reduction surgery were divided into 3 groups as follows: group 1 (n=9), the remnant tumor after operation existed only in the liver and the RTI was less than 5.0; group 2 (n=11), the remnant tumor after operation existed only in the liver and the RTI was greater than 5.0; and group 3 (n=5), extrahepatic metastatic tumor existed after operation.

Main Outcome Measures
Pathological findings and survival rate after surgery.

Results
There was no significant difference in the degree of macroscopic intrahepatic metastases among the 3 groups; however, both the portal vein invasion and the histological grade tended to be more severe in groups 2 and 3. The respective 1-year and 3-year survival rates for group 1 were 67% and 33%, and those for group 2 were 21% and 0%. There were no survivors in group 3 at 1 year after surgery. Significant differences were found in the survival rates between groups 1 and 2 (P<.05), and between groups 1 and 3 (P<.05).

Conclusion
Palliative reduction surgery for advanced HCC is only considered effective for patients with both an RTI of less than 5.0 and no extrahepatic metastasis.

Arch Surg. 1997;132:120-123

Author Affiliations
From the Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.

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