Micrometastasis Of Primary Liver Cancer And Defining Of Its Resection Margin

Up to now, surgical resection is the first choice for primary liver cancer ( PLC ), but it is still unsatisfactory because of the low resection rate and high incidence of intrahepatic recurrences. To the radical resection of PLC in various sizes, the optimal distance between the edge of lesion and the outer margin of transitional parenchyma, which is vital to a safe operation and a complete clearance of micrometastases in normal liver parenchyma surrounding the lesion, remains controversial and has not been well illustrated theoretically. What's more the prospective study with a large clinical sample has not been reported. In order to explore the optimal distance of resection margin ( RM ), the following studies were carried out.Part â…  Retrospective study of micrometastasis in 114 cases with PLCObjective The purpose of this study was to explore the distribution of micrometastases in PLC patients without any macroscopic tumor thrombi or macrosatellite found. Methods For entry into the study, patients should be selective with a histologically verfied PLC, and without macroscopic tumor thrombi or macrosatellite or extrahepatic metastases. From Nov. 2001 to Mar. 2003, 114 patients underwent 120 curative hepatectomies. And a retrospectively study was performed by microscopic examination of their routine pathological sections, including encapsulation, microscopic tumor thrombi or microsatellites and the distance between the edge of lesion and the outside of its farthest micrometastases. SPSS10.0 for Windows was used to determine the distribution of frequencies and SAS6.12 System to determine the statistical significance of difference for unpaired data. Results In 120 cases, there were 24 cases ( 20% ) with no encapsulation, 54 cases ( 45% ) with incomplete encapsulation and 42 cases ( 35% ) with nearly complete encapsulation. In 26 cases ( 21.67% ), micrometastases were found in liver parenchyma surrounding the lesions, among which, 16 cases companied with 27 microsatellites totally ( 1-10 per case ), 6 cases with 12 microscopic tumor thrombi ( 1-3 per case ), and 4 cases with 26 microscopic tumor thrombi ( 3-15 per case ) and 5 microsatellites ( 1-2 per case ). The farthest distance between the edge of lesion and the outside of its farthest micrometastases ranged within 3.9 mm, 5.9 mm and 6.7 mm in 95%, 99% and 100% cases, respectively. The check-out rate of micrometastases among the patients with incomplete encapsulation is higher statistically than those with no or complete encapsulation ( p<0.05 ). Conclusion The farthest distance between the edge of lesion and the outside of farthest micrometastases is within 6.7 mm in 100% PLC cases without macroscopic tumor thrombi or macrosatellites.Part â…¡ Prospective study of micrometastases in 77 cases with PLCObjective The purpose of this study focused on the further research about the distribution of micrometastases in PLC patients without positive preoperative imaging findings such as extrahepatic metastases, macroscopic tumor thrombi or macrosatellites and the relation between micrometastases and the clinicopathological characteristics of PLC. Methods For entry into this study, patients should be selected with a histologically verfied PLC and without macroscopic tumor thrombi or macrosatellites or extrahepatic metastases in preoperative imaging findings. From Mar. 2003 to Nov. 2003, 77 patients underwent curative hepatectomies. The resected liver specimens were studied prospectively to find out the shortest distance between the edge of lesion and the resection margin, macroscopic tumor thrombi or macrosatellites. At the same time, paraffin stained sections were prepared for microscopic examination including encapsulation, microscopic tumor thrombi or microsatellites and the distance between the edge of lesion and the outside of its farthest micrometastases. SPSS10.0 for Windows was used to determine the distribution of frequencies and SAS6.12 System to determine the statistical significance of difference for unpaired data. Results In 77 cases, there w...