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  1. 1. . .
  2. 2. Peter Paul Rubens ( Peter Paul Rubens (1577-1640): Prometheus Bound Philadelphia Museum of Art 2
  3. 3. 3
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  5. 5. 40-60 : - - - 5
  6. 6. 20-40 - 30% 10% : >5 OC HCC 6
  7. 7. 7 2012 21370 >75% 1993 2012 18410 - 5 1 22% 32% 5 8% - 13% Daniel Cherqui, et al. Surg Oncol Clin N Am 2008
  8. 8. 8 Natural history of HCC (n=102) 0 20 40 60 80 100 0 12 24 36 48 60 72 Probability(%) months Patients at risk 102 57 40 21 8 Median survival: 17m Number of deaths: 79 patients 54 % 40 % 28% Llovet JM. Hepatology, 1999, 29:62.
  9. 9. 1. HBV - HCV - - 2. 3. SGOT/SGPT, ALP, GGT, Bilirubin , AFP (70%) > 100ng/mL 9
  10. 10. - U/S echo - CT scan - MRI scan - FNA biopsy 10
  11. 11. - - 11
  12. 12. 12 Survival Following Resection for HCC Best candidates for resection : - Solitary HCC65 3000 20 6-12 15-30% 30-40% 5 15
  13. 16. 1. 2. 3. US,CT 4. CA 19.9, CEA 5. / 6. ALP 7. PSC 8. 16
  14. 17. Peripheral 7-20% Intrahepatic mass Cirrhosis uncommon Etiology unknown Hilar 40-60% Biliary confluence Most common Distal 20-30% 10-15% of peripancreatic tumors 17
  15. 18. 18
  16. 19. 0.000.250.500.751.00 0 20 40 60 analysis time Overall Survival Resected Margin negative (n = 259) Resected Margin positive (n = 172) Palliated (n = 133) 5-year Survival 30 % 10 % 2 % Median Survival 28 mo 16 mo 8 mo p < .001 Cholangiocarcinoma: Johns Hopkins Series (All Sites) p < .001 Resected margin pos (n=172) Palliated (n=133) Resected margin neg (n=259)
  17. 20. 20 CRC 3 3 150000 / 55000 / 35-55% 15-25% 20-25% 30-50% 10000-15000 / Rocha FG. HPB 2012
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  19. 22. 22 612 16-24 5 35-58% 10 20-25% Pawlik TM. The Oncologist 2008
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  22. 25. ONCOSURGERY CONSENSUS STATEMENT Adams RB. HPB 2013 25 Adam R. The Oncologist 2012
  23. 26. 26 Prediction: Survival in advanced colorectal cancer in 2015? 0 1 2 3 4 5 100 50 0 %surviving Years after diagnosis of colorectal metastases 2005 Median survival: Chemotherapy 24 mos. Overall >30 months 5 year survival: 1985 ~1% 1995 ~4% 2005 20% 2015 ?50% 8 mos 13 mos 30 mos 60 mos?