Masatoshi Makuuchi

Response Evaluation Criteria in Cancer of the Liver (RECICL) proposed by the Liver Cancer Study Group of Japan (2009 Revised Version)

The World Health Organization (WHO) criteria and Response Evaluation Criteria in Solid Tumors (RECIST) are inappropriate to assess the direct effects of treatment on the hepatocellular carcinoma (HCC) by locoreginal therapies such as radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE). Therefore, establishment of response evaluation criteria solely devoted for HCC is needed urgently in the clinical practice as well as in the clinical trials of HCC treatment, such as molecular targeted therapies, which cause necrosis of the tumor. Response Evaluation Criteria in Cancer of the Liver (RECICL) was revised in 2009 by Liver Cancer Study Group of Japan based on the 2004 version of RECICL, which was commonly used in Japan. Major revised points of the RECICL 2009 is to provide TE4a (Complete response with enough ablative margin) and TE4b (complete response without enough ablative margin) for local ablation therapy. Second revised point is that setting the timing at which the overall treatment effects are assessed. Third point is that emergence of new lesion in the liver is regarded as progressive disease, different from 2004 version. Finally, 3 tumor markers including alpha‐fetoprotein (AFP) and AFP‐L3 and des‐gamma‐carboxy protein (DCP) were also added for the overall treatment response. We hope this new treatment response criteria, RECICL, proposed by Liver Cancer Study Group of Japan will benefit the HCC treatment response evaluation in the setting of the daily clinical practice and clinical trials as well not only in Japan, but also internationally.

Segmentectomies, Sectionectomies, and Wedge Resections

Since hepatocellular carcinoma (HCC) and most metastatic diseases of the liver spread via intrahepatic portal branches, anatomical resection of a tumor bearing portal area, resection of a segment or a section, are basic procedures for treating liver tumors.

Clinico-pathological study and selection of treatment of large hepatocellular carcinoma larger than 10cm.

近約8年間に経験した最大径10cm以上の大型肝細胞癌31例を切除群 (19例) 非切除群 (12例) に分け臨床病理学的ならびに治療成績を比較検討した. 切除率は61.3%で切除群は右葉原発で肉眼的進行程度II, IIIまでにとどまるものが多く, 臨床病期も良好で肝硬変の併存は少なかった. 切除群では組織学的に被膜形成94.7%, 肝内転移78.9%, 門脈内腫瘍栓94.7%を認め, 耐術例の再発転移は76.5%と高率であったが集学的治療を積極的に行うことにより5年生存率は52.1%と良好であった.非切除群では進行した症例が多く肝動脈塞栓療法, 化学療法を行っても1年生存率はわずかに10.4%であった. 大型肝細胞癌の治療には切除術が最も有効であると考えられた.

Ultrasonically guided percutaneous pancreatography

Percutaneous pancreatography under ultrasonic guidance was first described by Cooperberg et al. in 1979. With the development of real-time ultrasonography, direct puncture of the pancreatic duct has become much easier and safer, as it has for other vessels and organs. Using a mechanical or electronic linear array real-time scanner, we began this procedure for percutaneous pancreatography in various pancreatic diseases in June, 1978, and have now accumulated sufficient experience with which to evaluate its clinical significance.