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Analysis Based on Tumor Hemodynamics

Masato Sakon, MD; Hiroaki Nagano, MD; Shoji Nakamori, MD; Keizo Dono, MD; Koji Umeshita, MD; Takamichi Murakami, MD; Hironobu Nakamura, MD; Morito Monden, MD

Arch Surg. 2002;137:94-99.

Hypothesis  Surgical margin, ie, the area of possible local intrahepatic metastasis, is controversial in hepatectomy for hepatocellular carcinoma.

Design  The blood drainage area of tumor was identified preoperatively by abdominal helical computed tomographic scan under hepatic arteriography and excised as surgical margin. The specimens were pathologically examined on the basis of the corresponding computed tomographic images.

Setting  University hospital.

Patients  From June 2, 1997, to April 24, 2000, 67 patients with hepatocellular carcinoma who underwent curative hepatic resection.

Main Outcome Measure  Intrahepatic recurrence.

Results  Blood drainage area of tumor could be classified into the following types. The marginal type (drainage into the peritumorous area) was frequent (50 cases) and excised mostly by nonanatomic, limited resection. Portal vein type (drainage into the portal branches) was less common (12 cases) and resected mostly by anatomically systematic hepatectomy. The remaining 5 cases were of the hypovascular type and underwent limited resection. Multiple nodules were frequently found inside the drainage area (4 of 8 cases) and were moderate or poorly differentiated hepatocellular carcinoma, consistent with intrahepatic metastasis. Solitary nodules were mostly outside the drainage area (11 of 12 cases) and contained well-differentiated hepatocellular carcinoma (7 of 10 cases), suggesting multicentric carcinogenesis. Intrahepatic recurrences were commonly found in bilateral or contralateral lobes (17 of 19 cases) and divided into 2 groups with a few (4) and multiple (8) recurrent nodules.

Conclusions  Surgical margin varied according to tumor hemodynamics. Tumor recurrences may result not only from multicentric carcinogenesis but also from intrahepatic metastasis via systemic circulation.

From the Departments of Surgery and Clinical Oncology (Drs Sakon, Nagano, Nakamori, Dono, Umeshita, and Monden) and Radiology (Drs Murakami and Nakamura), Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.

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