| セッション情報 | JDDW International Debate Session（Featured Lecture）1(JDDW)JDDW International Debate Session 「Treatment of small HCC （Surgery vs RFA）」 |
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| タイトル | IS1-1-1：Treatment of small HCC (Surgery vs RFA) |
| 演者 | M. Makuuchi（Japanese Red Cross Medical Center） |
| 共同演者 | |
| 抄録 | Detection of small HCC by AFP was a notable progress in the field of early detection of HCC, which had impelled surgeons to acquire technique of IOUS maneuvering, and introduced new surgical procedures of segmentectomy and subsegmentectomy (anatomical resection). RFA was introduced as a new ablation procedure in the late 1990s, and had proven its superiority over PEIT. However, RFA has its limits over intrahepatic metastases (IM). The rate of IM is high in HCC patients. The rate of IM has been reported to be 36.4% in patients with HCC ≦2.0cm, and 49.5% in patients with HCC of 2.1 - 3.0cm in diameter. In RFA, HCC itself and surrounding liver parenchyma may be ablated but is unable to treat microscopic IM. On the other hand, surgery can radically remove IM by ways of anatomical resection, in which the tumor bearing portal area are removed almost completely by staining the portal area with dye injection, and tracing the small tributaries of the hepatic veins in the liver parenchyma. These surgical techniques cannot be applied in RFA or laparoscopic liver resection. Open surgical procedure is, the only radical treatment available for IM. In fact, many retrospective studies with large number of patients reporting superiority of hepatectomy are available. The minimal invasiveness is the only advantage of RFA over open surgery. However, no mortality in more than 1,000 hepatectomies has already been reported, that if RFA wishes to claim its survival superiority, a concrete theoretical advantage of the procedure should be presented. |
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