Tumor size and operative risks of extended right-sided hepatic resection for hepatocellular carcinoma - Implication for preoperative portal vein embolization
Tumor size and operative risks of extended right-sided hepatic resection for hepatocellular carcinoma - Implication for preoperative portal vein embolization
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DOI：
10.1001/archsurg.142.1.63
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发表时间：
2007-01-01
影响因子：
--
通讯作者：
Wong, John
中科院分区：
文献类型：
--
作者：
Chik, Barbara H.;Liu, Chi Leung;Wong, John
假设：肝细胞癌（HCC）的大肝切除术与高手术发病率和死亡率相关，特别是对有潜在慢性肝病的患者。本研究评估了肝癌患者行右侧肝切除术后手术风险增加的相关因素。设计：回顾性研究。单位：三级转诊中心。患者：本研究回顾性分析了16年间（1989年1月1日至2004年12月31日）172例因肝癌行右侧肝切除超过4个Couinaud节段的患者，以评估与手术发病率和死亡率相关的临床因素。主要结局指标：与住院死亡率和主要手术发病率相关的危险因素。结果：总主要发病率为14.0%，住院死亡率为8.1%。在多因素分析中，小肿瘤、常规入路肝切除术、Child-Pugh级B肝硬化和既往存在的肿瘤破裂是与手术死亡风险增加显著相关的独立因素。判别分析显示，小于10 cm的肿瘤比大于10 cm的肿瘤明显增加手术死亡风险（17.2% vs 3.5%； P= 0.046）。结论：前路入路是肝细胞癌扩大右侧肝切除术的首选技术。小肿瘤患者的手术死亡风险增加，这与切除大量功能性肝实质有关。本组患者术前应考虑门静脉栓塞，增强右叶萎缩和未来残肝肥厚，降低手术风险。
Hypothesis: Major hepatic resection for hepatocellular carcinoma (HCC) is associated with high operative morbidity and mortality, especially in patients with underlying chronic liver disease. The present study evaluated the factors associated with increased operative risks in patients who underwent extended right-sided hepatic resection for HCC.Design: Retrospective study.Setting: Tertiary referral center.Patients: A retrospective study was performed on 172 patients who underwent extended right-sided hepatic resection of more than 4 Couinaud segments for HCC during a 16-year period (January 1, 1989, to December 31, 2004) to evaluate the clinical factors associated with operative morbidity and mortality.Main Outcome Measure: Risk factors associated with hospital mortality and major operative morbidity.Results: The overall major morbidity and hospital mortality rates were 14.0% and 8.1%, respectively. On multivariate analysis, small tumor size, conventional-approach hepatectomy, Child-Pugh grade B cirrhosis, and preexisting tumor rupture were the independent factors significantly associated with an increased risk of operative mortality. Discriminant analysis showed that a tumor size smaller than 10 cm significantly increased the risk of operative mortality compared with larger tumors (17.2% vs 3.5%; P=.046).Conclusions: Anterior approach is the preferred technique for extended right-sided hepatic resection for HCC. Increased risk of operative mortality was identified in patients who had a small tumor, which was associated with the resection of a large volume of functioning liver parenchyma. Preoperative portal vein embolization should be considered in this group of patients to enhance atrophy of the right lobe and hypertrophy of the future liver remnant to minimize the operative risk.