Surgery and interventional radiology in the treatment of liver cancer

The treatment results of more than 800 patients with primary and metastatic liver malignancies including 120 with hepatic resections are analyzed in comparison with the literature data. Modern tendencies in the tactics of management for liver tumors are reviewed. It is noted that curable liver resection is still the main surgical procedure in liver malignancies. Re-resection has become a routine intervention but is possible in less than 20 per cent of patients. In the last years, liver transplantation appears as an alternative curable treatment of hepatocellular carcinoma. There is improvement of results of «debulking» surgical procedures combined with locoregional chemotherapy. No positive effects of preoperative arterial infusion or chemoembolization for resectable liver tumors were found. On the other hand, preoperative portal vein embolization is widely used for decreased risk of postoperative hepatic failure. The efficacy of adjuvant arterial and portal vein chemotherapy is not fully proven. Periodical hepatic artery and portal vein chemoembolizations appear to be effective for this purpose. Combination of regional chemotherapy and local ablation (ethanol injection, radiofrequency, laser, cryosurgery) are reasonable for the management of unresectable recurrent liver cancer. It is concluded that multimodality approach including methods of surgery and interventional radiology should be preferred for hepatic malignancies. Use of this approach improves treatment results.