Surgery of liver tumors.

Hepatic neoplasms, primary and metastatic, are best treated with surgery. The present report summarizes the results of various surgical procedures used during the last eight years in the management of 310 patients with liver neoplasms. Exploratory laparotomy was the ultimate diagnostic test, determining resectability of the lesion. Percutaneous liver biopsy was discouraged and was used only in the presence of obvious distant metastasis. Primary and metastatic neoplasms confined to the liver were managed with lobectomy, hepatic trisegmentectomy, or left lateral segmentectomy whether they were solitary or multifocal; the choice of procedure depended on their location. Tumors invading major vascular structures were resected using a new method of hepatic isolation/hypothermic perfusion. Neoplasms involving the entire liver were managed with intrahepatic infusion chemotherapy administered directly into the hepatic circulation through percutaneous catheters. Selected individuals with unresectable lesions were treated with vascular isolation and perfusion of the liver with chemotherapeutic agents. Budd-Chiari syndrome caused by malignant obstruction of hepatic outflow was managed either with isolation/hypothermic perfusion and resection or with hepatic artery ligation and infusion of chemotherapeutic agents. Total hepatectomy with orthotopic liver transplantation was reserved for a few highly selected individuals. The results obtained with these procedures were encouraging. Major hepatic resection was performed with a 9% operative mortality and resulted in an 81% 3-year actuarial survival if the disease was limited to the liver. Palliative major resection in a 31% 3-year actuarial survival. Intrahepatic infusion of chemotherapeutic agents was effective when the dosage was adequate and proved superior to peripheral intravenous treatment. Isolation perfusion of the liver permitted resection of lesions which could not have been managed by conventional procedures. The effectiveness of isolation chemotherapy perfusion of the liver was tempered by leakage of Actinomycin-D into the systemic circulation. The results is this series of patients encourage the judicious use of these procedures in the management of the patient with liver cancer. A pessimistic attitude often based on preoperative evaluation alone without the benefit of exploratory laparotomy ought to be discouraged.