| Abstract: |
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver as it accounts for 90% of primary liver cancers and causes at least 1 million deaths world-wide per year. It is the 5th most common cancer in the world and the 4th in annular mortality. Liver cirrhosis is found in the majority of cases which not only a major problem for achieving successful treatment but also promoting intrahepatic invasion and metastases of HCC.There are many risk factors in addition to liver cirrhosis, hepatitis C viral infection (HCV), Hepatitis B-viral infection (HBV) Hemochromatosis, chronic alcoholism and Aflatoxin. Diagnosis of HCC can be assessed by means of one or more imaging modalities (ultrasonography, triphasic CT, and magnetic resonance image MRI), in addition to elevated serum level of Alfa-Feto protein (AFP) above the diagnostic value (500 ng/ml).Unfortunately, most HCC (about 50%) discovered in a late stage (unresectable). The prognosis of HCC remains relatively poor despite of the intense efforts for the development of novel treating modalities.The present study comprised 50 patients with HCC. Each patient was subjected to history taking, clinical examination, full laboratory investigations (CBC, LFT, KFT, PT, PC and INR, AFP serum level, viral markers), radiological investigations (plain X-ray chest, abdominal ultrasound, triphasic CT liver and TACE in 2 cases).HCC more common in men as men to women ratio was 68.3% to 31.7%. Patients age range was 34-75 years with mean of 51.17 years. No specific clinical features were characterizing HCC, however the most common feature was pain in the right hypochondrium and epigastruim (54%).Pre-operative serum level of AFP >500 ng/ml was found in 68% of patients, and after resection 10.4% of patients still had elevated serum AFP above the diagnostic value.Hepatitis C viral infection (HCV) was present in 80% of patients, but HBV infection occurred in 4% of patients, while both infections were present in 6% of. Ten percent of patients gave negative markers.Triphasic CT has diagnostic criteria for HCC without any need for tissue biopsy. Abdominal Ultrasonography can detect focal lesion (>1.5 cm in diameter), but can’t differentiate between focal benign and malignant lesions.Preoperative assessment was done on the selected 50 HCC patients who were probable candidate for hepatic resection. Child’s class A patients were 43 patient’s (86%) and 7 patients (14%) were child’s class B. After full investigations, 22 patients were excluded from resection. Three patients (6%) had liver insufficiency, two patients (4%) had persistent hypoprothrombinemia, four patients (8%) due to marked thrombocytopenia, six patients due to portal vein thrombosis. Marked liver cirrhosis was found in three patients (6%), porta-hepatis L.N. enlargement in two patients (4%), one patient with large right lobe HCC with small left lobe and the last patient with left lobe HCC and uncontrolled D.M.Liver cirrhosis was present in 37 patients (82.2%), tumors less than 3cm were present in 24 patients (53.3%), tumors size between 3 -5 cm were present in 19 patients (42.2%) and tumor size over 5cm were present in 7 patients (15.5%).Twenty eight patients were subjected to surgery and 23 patients (81.2%) underwent liver resections.The 23 patients (81.2%), who underwent liver resection, were classified as: 5 patients (17.8%) underwent left lateral Hepatectomy, one patient (3.6%) underwent extended right hepatectomy, 2 patients (7.1%) underwent segmental resection, 2 patients (7.1%) underwent right lobectomy, Non anatomical resection was done in 13 patients (46.4%), 2 patients (7.1%) represented with ruptured HCC, and wedge resection was performed for them, Habib sealer technique was done in 2 patients (7.1%) and tumor resection with safety margin was done in 7 patients (21.4%). One patient (3.6%) underwent multiple excision of 3 HCCs of right lobe. Another patient (3.6%) underwent multiple excision of 2 HCCs of right lobe. Non resection was done in 5 patients (17.8%). The mean operative time was 215 + 37 minutes, the peri-operative mortality was 4 patients (17.4%).The most common post-operative morbidity was impaired liver function, and this was presented with ascitis (3 patients), lower limb edema (5 patients) and confusion in 3 patients. The first year mortality (including the peri-operative) was 7 patients (30.4%). Tumor recurrence occurred in 4 patients (17.4%) within the first year, where 3 of them died and the 4th was subjected to TACE followed by resection.Follow up for the patients was done every 3 months including clinical examination, AFP serum level, abdominal U/S and triphasic CT of the liver.
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