Comprehensive treatment of liver cancer

  The treatment of liver cancer is a comprehensive treatment mainly based on surgery. Surgery-based comprehensive treatment is the key to reduce the postoperative recurrence rate and improve the survival rate of liver cancer patients. With the changing concept of hepatocellular carcinoma treatment in recent years, large hepatocellular carcinoma can be resected in one stage, early postoperative vascular interventional embolization treatment, recurrent hepatocellular carcinoma re-excision or local microwave, radiofrequency, anhydrous alcohol treatment, as well as the application of traditional Chinese medicine and biological immunotherapy, which significantly improve the survival rate of hepatocellular carcinoma.  Surgical resection is still the main treatment for hepatocellular carcinoma, and is the most important measure to improve the cure rate and survival. What needs to be emphasized is the intraoperative tumor-free technique and the safety limit of the surgical margin from the tumor. Since most of liver cancers in China are combined with cirrhosis, regular hepatectomy is not emphasized. Irregular local resection can be adopted according to the patient’s condition, but the safety limit of 2 cm must be guaranteed. For patients with small hepatocellular carcinoma in the central part of liver combined with more severe cirrhosis, it is still better to treat with microwave or radiofrequency. Post-surgical liver failure is related to a number of factors, the most likely factors being the patient’s heavy cirrhosis, poor preoperative liver function, large intraoperative bleeding, long intraoperative hepatic portal block, and the large amount of surgical liver resection, which makes it difficult for the remaining liver to withstand normal anabolic functions. It is very important to correctly assess the patient’s liver function and the allowed amount of liver resection before surgery. Intraoperative control of bleeding and shortening the duration of hilar block or performing hemihepatic block are the main measures to reduce postoperative liver failure. Re-operation for recurrent tumors can still achieve a good survival rate.  The necessity and flexibility of postoperative chemoembolization with hepatic artery cannulation. In this group of patients, hepatic arteriography via femoral artery cannulation was routinely performed 1 month, 2 months and 3 months after surgery to understand the presence of residual lesions in the liver. If there was no sign of recurrence, patients were given prophylactic chemotherapy. If residual lesions were found, chemoembolization was given to control the disease. After TACE, CT will be repeated to get a clear picture of the tumor. In case of recurrence, depending on the situation, surgical resection, radiofrequency, anhydrous alcohol injection or continued TACE treatment with TCM and bioimmune agents will be given.  Local treatment such as radiofrequency or anhydrous alcohol after TACE is an important method to improve the cure rate and survival rate for some patients who cannot be surgically resected. It is also clinically known as dual interventional treatment, i.e. vascular intervention and organ intervention. Vascular interventions control the blood supply to the liver tumor and cause ischemic necrosis of the tumor. However, the periphery of tumor is mainly supplied with blood via portal vein, so it is difficult to completely block all blood supply of tumor by hepatic artery chemoembolization alone. It can be combined with radiofrequency treatment. For small recurrent foci, anhydrous alcohol injection is more economical and convenient, and can also achieve better results. However, for patients with heavy cirrhosis, the diffusion of alcohol is difficult to expand concentrically, so multiple injections should be performed.  Hepatocellular carcinoma patients with a history of hepatitis B or C account for 92.0%, and postoperative recurrence may be related to the replication of hepatitis virus in patients. For patients with hepatitis B major triple-positive or HBV-DNA positive, postoperative antiviral therapy such as Herceptin, interferon and thymidine, together with traditional Chinese medicine and other treatments to inhibit viral replication, can reduce the recurrence rate of liver cancer.