Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey
Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey
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DOI：
10.1016/j.surg.2007.12.003
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发表时间：
2008-04-01
期刊：
影响因子：
3.8
通讯作者：
Takayasu, Kenichi
中科院分区：
文献类型：
--
作者：
Eguchi, Susumu;Kanematsu, Takashi;Takayasu, Kenichi
背景。虽然手术切除是治疗肝细胞癌（HCC）的一种重要方式，但手术方法对患者生存和无病生存（DTS）的影响仍存在争议。使用日本全国数据库，1994年至2001年间接受根治性肝切除术的72,744例HCC患者根据是否进行解剖性亚节段切除术（AS）或非解剖性小肝切除术（MH）分为两组。研究共选择了5781例单发hcc患者，并根据hcc的大小（直径小于2cm、2 ~ 5cm和大于5cm）分为3个亚组。2267例患者接受了AS， 3514例患者接受了MH。AS后患者的总体DTS明显改善（P = 0.0089）。按肝细胞癌大小分层时，AS术后2 ~ 5 cm的肝细胞癌患者DES较好（P < .0005）。根据肝损害进一步分层显示AS和mh之间没有任何显著差异。因此建议行AS，特别是当HCC的大小在2 - 5cm之间时。
Background. Although a surgical resection is an important modality for the treatment of hepatocellular carcinoma (HCC), the impact of the operative method on both the patient survival and disease-free survival (DTS) still remains controversial.Methods. Using a nationwide Japanese database, 72,744 patients with HCC who underwent a curative liver resection between 1994 and 2001 were divided into two groups based on whether an anatomical subsegmentectomy (AS) or a non-anatomical minor hepatectomy (MH) was performed. A total of 5, 781 patients with single HCCs were selected for the study and divided into 3 subgroups based on the size of the HCCs (less than 2cm, 2 to 5 cm, and greater than 5 cm in diameter). An AS was performed for 2,267 patients while an MH was performed for 3,514 patients.Results. The overall DTS was significantly better after an AS (P = .0089). When the patients were stratified according to the size of the HCC, a better DES was seen in the patients with HCC from 2 to 5 cm after an AS (P < .0005). Further stratification according to liver damage did not show any significant differences between an AS and an MH.Conclusion. An AS is therefore recommended, especially when the size of HCC ranges from 2 to 5 cm.