Current Status of Primary Liver Cancer Treatment as of May 6, 2001

Current Status of Primary Liver Cancer Treatment as of May 6, 2001

China accounts for 42.5% of global liver cancer cases, and over the past two decades, both the mortality and incidence rates of liver cancer in China have risen sharply. The introduction of alpha-fetoprotein testing in the 1970s, advances in ultrasound technology in the 1980s, and further development of biological diagnostic techniques in the 1990s created the necessary preconditions for surgical treatment of liver cancer. Domestically, extensive experience has been accumulated in routine liver resection, normothermic hepatic vascular occlusion resection, bloodless liver resection, and local radical surgery, resulting in the world’s largest database of liver resection cases. According to statistics from Academician Wu Mengchao at the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University in Shanghai, a total of 3,932 liver cancer surgeries were performed between 1966 and 1996, with a five-year survival rate of 36.1%. Among the 28,000 hospitalized liver cancer patients, fewer than 20% underwent surgery. Before 1977, the five-year survival rate for surgical patients was 16.0%; from 1978 to 1988, it rose to 30.6%; and after 1990, it reached 48.6%, demonstrating progress in liver cancer surgery in China. The following aspects should be considered in the treatment of liver cancer:

1. Early resection No metastasis, tumor size <5 cm; if multiple tumors, the total diameter should be <5 cm. The standard set by Changhai Hospital is <3 cm, with a five-year survival rate of 79.0% for small liver cancers, including 83.3% for those under 3 cm.

2. Transarterial Chemoembolization (TACE) Preoperative TACE usually shrinks the tumor and reduces the surgical wound, but some scholars oppose it, arguing that it may cause cancer cells to detach from each other, increasing the risk of postoperative recurrence.

3. Intraoperative prevention Efforts should be made to minimize compression and traction on the liver, and cut surfaces should be treated, such as by embedding them in sponge soaked in anhydrous alcohol or chemotherapy drugs. In recent years, microwave ablation and cryotherapy have also been used. Visible intravascular tumor emboli should be removed in small amounts. Portal vein or hepatic artery infusion devices can also be considered.

4. Postoperative comprehensive treatment Postoperative chemotherapy, traditional Chinese medicine, immunotherapy, and drug delivery systems (DDS) can all enhance survival and reduce or delay recurrence. In recent years, there have been many reports on postoperative transarterial chemoembolization (TACE), and scholars generally agree that this method can prolong disease-free survival, especially for patients with good liver function. In addition, oral 5-FU combined with protective drugs such as calcium tetrahydrofolate has shown certain anti-recurrence effects.

5. Prediction of liver cancer recurrence and metastasis Factors that increase the likelihood of recurrence include multiple tumors, large resection margins, vascular branch tumor emboli, and ascites. In summary, surgical treatment of liver cancer has made great strides over the past two decades, with a five-year survival rate of up to 79% for early-stage liver cancer and 83.3% for tumors under 3 cm.