Hepatic resection and percutaneous ethanol injection for the treatment of selected patients with more than one hepatocellular carcinoma

Objective: To report our results in a selected series of patients who had two separate hepatocellular carcinomas that were not suitable for treatment by resection alone or percutaneous injection of ethanol alone, whom we treated by a combination of the two. Design: Open study. Setting: Teaching hospital, Italy. Subjects: 11 patients with Child's grade A or B cirrhosis who had two hepatocellular carcinomas in distant segments of the liver. Interventions: Percutaneous injection of ethanol into the smaller of the two nodules before, during, or after resection. Main outcome measures: Morbidity, mortality, and recurrence. Results: No patient died and there was one postoperative complication (atelectasis). During a median follow-up period of 24 months (range 8-48) two patients have developed recurrences (at 10 and 18 months). Conclusion: Although we have studied only a few patients for a relatively short time this double approach may be an important treatment option for suitable patients with two hepatocellular carcinomas.