Hepatocellular carcinoma: Current surgical management
Hepatocellular carcinoma: Current surgical management
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DOI：
10.1053/j.gastro.2004.09.039
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发表时间：
2004-11-01
期刊：
影响因子：
29.4
通讯作者：
Fong, YM
中科院分区：
文献类型：
--
作者：
Song, TJ;Ip, EWK;Fong, YM
肝细胞癌（HCC）是世界上第五大常见恶性肿瘤，每年造成全球50万人死亡。虽然HCC是一种生长缓慢的肿瘤，但它通常是快速致命的，因为它通常直到疾病进展时才被发现。HCC主要发生在肝硬化患者中，这种情况增加了进行潜在治愈性手术治疗的风险。然而，在过去的20年里，由于放射学评估、患者选择和围手术期护理的进步，手术切除的安全性大大提高。因此，肝切除术的手术死亡率已从20世纪80年代的10%-20%降至今天的5%以下。HCC治疗的最终目标是通过根除恶性肿瘤同时保留肝功能来延长生活质量。对于具有治愈目的的治疗，金标准仍然是手术切除，通过部分肝切除术或全肝切除术，然后进行肝移植。手术的可切除性和选择取决于许多因素，包括基线肝功能、无肝外转移、残留肝脏的大小、包括肝移植在内的资源的可用性以及手术团队的专业知识。无肝硬化的患者可以耐受广泛切除，应首先考虑部分肝切除。对于Child分级为B和C级的小肝癌患者，肝移植效果最好，而部分肝切除适用于代偿良好的肝硬化患者。活体肝移植应采用与尸体肝移植相同的标准。
Hepatocellular carcinoma (HCC) is the fifth most common malignancy in the world, responsible for 500,000 deaths globally every year. Although HCC is a slow-growing tumor, it is often rapidly fatal because it is usually not discovered until the disease is advanced. HCC occurs primarily in individuals with cirrhosis, a condition that increases the risk of performing potentially curative surgical therapy. Over the last 2 decades, however, the safety of surgical resections has greatly improved because of advances in radiologic assessment, patient selection, and perioperative care. As such, the operative mortality rate for hepatectomy has decreased from the 10%-20% level seen in the 1980s to less than 5% today. The ultimate goal of treatment of HCC is to prolong the quality of life by eradicating the malignancy while preserving hepatic function, For treatment with a curative intent, the gold standard remains surgical resection, by either partial hepatectomy or total hepatectomy followed by liver transplantation. Resectability and choice of procedure depend on many factors, including baseline liver function, absence of extrahepatic metastases, size of residual liver, availability of resources including liver graft, and expertise of the surgical team. Patients without cirrhosis can tolerate extensive resections, and partial hepatectomy should be considered first. For Child class B and C patients with a small HCC, liver transplantation offers the best results, whereas partial liver resection is indicated in patients with well-compensated cirrhosis. Living donor liver transplantation should be considered using the same criteria as that used for cadaveric transplantation.