Arii S, Teramoto K, Kawamura T, Okamoto H, Kaido T, Mori A, Imamura M
Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
J Hepatobiliary Pancreat Surg. 2001;8(5):397-403. doi: 10.1007/s005340100000.
A nationwide survey conducted by the Liver Cancer Study Group of Japan showed that approximately 85%-90% of recurrences of hepatocellular carcinoma (HCC) were in the remnant liver, and that the location of the intrahepatic recurrence was widely distributed throughout the entire liver, with 30%-40% of the recurrences on the side opposite the primary tumor, beyond Cantlie's line. In our experience, about 70% of the recurrences were seen within 2 years after surgery, and the survival rate tended to be lower as the period from the primary surgery to the recurrence was shorter. To achieve longer survival in patients with HCC, one of the most important issues is, therefore, how to prevent and control intrahepatic recurrence after surgery. Although, according to the nationwide survey, repeat hepatectomy has been performed in only 1.6% of all patients with intrahepatic recurrence, we have experienced 28 patients with repeat hepatic resection. The 1-, 3-, and 5-year survival rates from the time of re-resection were 93%, 59%, and 47%, respectively, and survival rates from the time of the initial surgery were 85% at 3 years, 62% at 5 years, and 53% at 8 years. In particular, in patients with a second primary cancer from multicentric carcinogenesis, the 5-year survival rate after the re-resection was approximately 80%. These results suggested that repeat hepatectomy should be recommended for selected patients.
日本肝癌研究小组开展的一项全国性调查显示，肝细胞癌（HCC）复发的患者中约85%-90%出现于残余肝脏，肝内复发的位置在整个肝脏广泛分布，30%-40%的复发位于主瘤对侧，超出坎特利线。根据我们的经验，约70%的复发发生在术后2年内，从初次手术到复发的时间越短，生存率往往越低。因此，为使HCC患者获得更长生存期，最重要的问题之一是如何预防和控制术后肝内复发。尽管根据全国性调查，在所有肝内复发患者中仅1.6%接受了再次肝切除术，但我们有28例患者接受了再次肝切除。再次切除后的1年、3年和5年生存率分别为93%、59%和47%，初次手术时的3年、5年和8年生存率分别为85%、62%和53%。特别是对于多中心发生的第二原发性癌症患者，再次切除后的5年生存率约为80%。这些结果表明，对于选定的患者应推荐再次肝切除术。
