Survival and recurrence after hepatic resection of 386 consecutive patients with hepatocellular carcinoma
Survival and recurrence after hepatic resection of 386 consecutive patients with hepatocellular carcinoma
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DOI：
10.1016/s1072-7515(00)00700-6
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发表时间：
2000-10-01
影响因子：
5.2
通讯作者：
Amano, J
中科院分区：
文献类型：
--
作者：
Hanazaki, K;Kajikawa, S;Amano, J
背景：尽管肝切除术是治疗肝细胞癌最有效的方法之一，但肝切除术的远期疗效并不令人满意。肝切除术对肝细胞癌患者的潜在益处尚未完全阐明。这项研究旨在确定连续386例接受肝切除的肝细胞癌患者的手术结果。研究设计：这项回顾性研究观察了293名男性和93名女性的记录。平均年龄63.2岁。术前肝动脉化疗栓塞术138例(35.8%)，门静脉栓塞术8例(2.1%)。大手术62例(16.1%)，小手术324例(83.9%)。结果：30d手术死亡率为4.1%，晚期死亡11例(2.9%)。根治性切除术后复发214例(65.4%)。手术切除、ChildB级或C级、肝硬变、吲哚青绿保留-15值高、术中大量失血、NI期疾病、切缘阳性、血管侵犯和术后并发症是影响患者生存和复发的主要因素。术前肝动脉化疗栓塞术增加复发率，对预后无明显影响。目前，106名患者(27.5%)仍然健在：7名患者(1.8%)超过10年，43名患者(11.1%)超过5年。术后平均总生存期38个月，中位生存期29个月。肝切除术后5年和10年总或无瘤生存率分别为34.4%和10.5%，23.3%和7.8%。结论：术后长期生存率仍不理想，主要原因是复发率较高。术前应避免经动脉化疗栓塞术，因为术后复发的风险很高。术后复发的肝细胞癌的治疗策略对改善预后有重要作用，特别是对ChildB级以上、肝硬变、吲哚青绿保留-15值高、术中大量失血、IV期疾病、切缘阳性、血管侵犯和术后并发症的患者。《外科外科杂志》2000；191：381-388。(C)2000年由美国外科医师学会颁发)。
Background: Although hepatic resection is one of the most effective treatments for hepatocellular carcinoma (HCC), the longterm results of hepatic resection of this malignancy are far from satisfactory. The potential benefits of hepatectomy for patients with HCC have not been fully delineated. This study aimed to identify surgical outcomes of 386 consecutive patients with HCC undergoing hepatic resection.Study Design: The retrospective study looked at records of 293 men and 93 women. The mean age was 63.2 years. Preoperative transarterial chemoembolizaton and portal vein embolization were performed in 138 patients (35.8%) and 8 patients (2.1%), respectively. Sixty-two patients (16.1%) had major hepatectomy and the other 324 (83.9%) had minor hepatectomy. Thirty-seven of 386 patients (9.6%) had a noncurative operation.Results: The 30-day (operative) mortality rate was 4.1%, and there were 11 additional late deaths (2.9%). Two hundred fourteen of 327 patients (65.4%) had recurrence after curative resection. Unfavorable factors for survival and recurrence were resection between 1983 and 1990, Child class B or C, cirrhosis, a high value of indocyanine green retention-15, a large amount of intraoperative blood loss, stage ni disease, positive surgical margin, vascular invasion, and postoperative complications. Preoperative transarterial chemoembolization increased the recurrence rate and showed no contribution to prognosis. Currently, 106 patients (27.5%) are alive: 7 (1.8%) after more than 10 years and 43 (11.1%) after more than 5 years. Mean and median overall survivals after operation were 38 months and 29 months, respectively. The 5-year and 10-year overall or disease-free survival rates after hepatic resection were 34.4% and 10.5% or 23.3% and 7.8%, respectively.Conclusions: The longterm survival rate after operation remains unsatisfactory mainly because of the high recurrence rate. Preoperative transarterial chemoembolization should be avoided because of a high risk of postoperative recurrence. Treatment strategies for recurrent HCC may play an important role in achieving better prognosis after operation, especially in patients with more than Child class B, cirrhosis, high values of indocyanine green retention-15, massive intraoperative blood loss, stage IV disease, positive surgical margin, vascular invasion, and postoperative complications. (J Am Coll Surg 2000;191:381-388. (C) 2000 by the American College of Surgeons).