The most effective therapeutic modality for hepatoma is complete resection, but this is possible in only 40-50% of patients. Chemotherapy plays an ancillary role in eradicating subclinical metastases in completely resected disease and chemotherapy plus radiation therapy may be effective in permitting initially unresectable disease to become resectable.
The optimal management of hepatoma is complete resection. Patients who are suitable candidates for complete resection include those with:
1. Tumors confined to the right lobe
2. Tumors originating in the right lobe that do not extend beyond the medial segment of the left lobe
3. Tumors confined to the left lobe.
Patients who have tumor involvement of both lobes are not candidates for curative surgical resection. In these cases, biopsy should be performed.
Radical hepatic resection results in many potential postoperative complications, including the following:
• Hypofibrinogenemia and deficiency of coagulation proteins.
Hyperbilirubinemia persists for 2-4 weeks after resection, and hepatic regeneration is complete by 1-3 months postsurgery.
Table 24-16. Staging of Hepatoma in Children and Percentage of Cases
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