127 MEDICINA (2004) 40 tomas, Nr. 2 KLINIKINIAI TYRIMAI Results of treatment of primary liver cancer at Kaunas University of Medicine Hospital Mindaugas Jievaltas, Laura Stoškuvienė 1 , Vitalija Petrenkienė 2 , Giedrius Barauskas, Juozas Pundzius Clinic of Surgery, Kaunas University of Medicine Hospital, 1 Faculty of Medicine, Kaunas University of Medicine, 2 Clinic of Gastroenterology, Kaunas University of Medicine Hospital, Lithuania Key words: hepatocellular carcinoma, liver resection. Summary. Though the results of treatment of primary liver cancer depend on many circumstances, the opportunity to perform a curative liver resection remains the main point in prognosis on survival. The aim of the study was to examine our first experience in the treatment of liver cancer. From 1996 to 2001 we observed 54 patients with liver cancer: 46 hepatocellular and 6 cholangiocellular carcinomas, 1 malignant carcinoid, and 1 carcinosarcoma. In presence of liver cirrhosis (21 patients, 38.8%) hepatic function was evaluated using Child Pugh classification. Lesions were multiple in 28 cases and single in 26 cases. Ten patients (18.5%) were radically resected, 12 patients (22.2%) were managed by laparotomy and biopsy, 2 by percutaneous ethanol injections, 1 by trans-ileocolic portal vein embolization + hepatic artery embolization. There were 7 deaths (28%) and 18 complications (72%) after the surgical treatment. The survival results of patients who underwent resection were better (median 240 days) compared with palliative treatment group (median 113.3 days); by Log-Rank test p=0.208. Conclusion. The use of liver resections in patients affected by single or monolateral liver cancer is effective and potentially radical treatment. Mortality and morbidity rate is high. Alternative therapies can be conveniently considered in case of multicentric Child B–C patients. Correspondence to M. Jievaltas, Clinic of Surgery, Kaunas University of Medicine Hospital, Eivenių 2, 3007 Kaunas, Lithuania. E-mail: Minjiev@yahoo.com ; Minjiev@kmu.lt Introduction Hepatocellular carcinoma (HCC) is the most com- mon morphologic form of primary liver cancer. Sur- gical excision of tumor is the only proven curative the- rapy (1). Five-year survival rate after curative liver resection differs in various countries and reaches 27– 49% in the Western countries, and 10–46% in the Far East (1–7). According to the literature mortality rate after hepatic resection varies from 3.6% to 19% (1– 9). The progressing liver failure is the most common mortality cause after liver resection (1). The majority of cases of HCC occur in areas where viral hepatitis is endemic. For example, in Japan, 75% of cases are asso- ciated with hepatitis C infection (10); in China, hepatitis B infection is found in 80% of cases (11). The majority of published experience examining treatment for HCC is therefore understandably from the Far East, and the patients reported almost uniformly have underlying liver disease (and also liver cirrhosis). This circums- tance influences the results of treatment and survival rate, therefore the underlying liver cirrhosis often de- termines the choice of treatment. The morbidity rate of primary liver cancer in Lithu- ania is not so high. According to Lithuanian Cancer Register data, 3.5 new cases were observed per 100,000 inhabitants in 2000. It totaled to 129 new cases in the whole country (12). This disease is rather rare and that is why we do not have much experience of treating it in our country. Only a few articles reporting data of studies performed on this topic in Lithuania are avai- lable. The aim of our work was to determine the results of treatment of primary liver cancer in Kaunas Uni- versity of Medicine Hospital (KUMH) of the latest years. Methods Fifty-four patients with primary liver cancer re- ceived the treatment in the Clinic of Surgery and Clinic of Gastroenterology of KUMH between 1995 and