Equivalent Outcomes After Anatomical and Non-anatomical Resection of Small Hepatocellular Carcinoma in Patients with Preserved Liver Function
Equivalent Outcomes After Anatomical and Non-anatomical Resection of Small Hepatocellular Carcinoma in Patients with Preserved Liver Function
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DOI：
10.1007/s10620-012-2114-7
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发表时间：
2012-07-01
影响因子：
3.1
通讯作者：
Nagano, Hiroaki
中科院分区：
文献类型：
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作者：
Tomimaru, Yoshito;Eguchi, Hidetoshi;Nagano, Hiroaki
虽然解剖切除术（AR）被认为比非解剖切除术（NAR）更好地治疗肝细胞癌（HCC），只有有限的证据支持这一论点。本研究的目的是调查AR是否上级NAR对小孤立性HCC和保留肝功能患者的术后结局。研究对象为92例治愈性肝癌患者。具有足够肝功能储备的切除患者（15 min时吲哚菁绿色留存率<15%，凝血酶原时间> 70%，血清白蛋白> 3.5 g/dl）和肉眼可见小（千分之一货币符号3.0 cm）孤立性HCC，无肉眼可见血管侵犯; 30例患者接受AR，62例患者接受NAR。比较两组患者术后近期疗效（包括死亡率、并发症发生率）和远期疗效，两组患者的临床病理背景无显著性差异。虽然AR组切除的肝脏体积明显大于NAR组（p < 0.0001），但在死亡率或发病率方面没有发现显著差异。对于长期结果，两组在无病生存期或总生存期方面没有显著差异。多因素分析显示，手术范围不是无病生存率或总生存率的重要预后因素。与肝功能正常的患者相比，孤立性小肝癌的AR并不具有术后预后优势。我们推荐NAR用于保留肝功能的孤立性小肝癌患者的肝切除术。
Although anatomical resection (AR) is considered better than non-anatomical resection (NAR) for the treatment for hepatocellular carcinoma (HCC), there is only limited evidence in support of this argument.The aim of this study was to investigate whether AR is superior to NAR regarding postoperative outcomes in patients with small solitary HCC and preserved liver function.The study subjects were 92 curatively-resected patients with adequate liver function reserve (indocyanine green retention rate at 15 min < 15%, prothrombin time > 70%, serum albumin > 3.5 g/dl) and macroscopically small (a parts per thousand currency sign3.0 cm) solitary HCC without macroscopic vascular invasion; 30 patients underwent AR and 62 patients NAR. Postoperative short-term outcomes including mortality and morbidity and long-term outcomes were compared in the two groups.There was no significant difference in clinicopathological background in the two groups. Although resected liver volume was significantly larger in the AR group than the NAR group (p < 0.0001), no significant differences were detected in the incidence of mortality or morbidity. For long-term outcomes, there were no significant differences between the two groups in disease-free survival or overall survival. Multivariate analysis showed that the extent of surgical procedure was not a significant prognostic factor for disease-free or overall survival.AR of a solitary small HCC did not carry postoperative outcome advantages compared with NAR in patients with preserved liver function. We recommend NAR for hepatic resection of small solitary HCC in patients with preserved liver function.