Tanaka Shinji, Shimada Mitsuo, Shirabe Ken, Maehara Shin-Ichiro, Tsujita Eiji, Taketomi Akinobu, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Am J Surg. 2005 Sep;190(3):451-5. doi: 10.1016/j.amjsurg.2004.12.005.
Hepatocellular carcinoma (HCC) originating in the caudate lobe is rare, and the treatment for this type of carcinoma is difficult because of its unique anatomic location.
This retrospective study assessed the surgical outcome of patients with caudate lobe HCC. There were 20 cases of HCC originating in the caudate lobe among 435 patients with primary HCC who underwent hepatic resection in our department from 1990 to 2002. The caudate tumors were located in the Spiegel lobe in 3 patients, the paracaval portion in 15 patients, and the caudate process in 2 patients. Surgical procedures consisted of limited resection of the caudate lobe in 6 patients and extended caudate lobectomy in 14 patients. Recurrence was recognized in 12 patients, including 8 patients with multiple intrahepatic recurrences, 1 with peritoneal dissemination, and 1 with lymph node metastasis.
There was no significant difference in postoperative survival rate between patients who underwent limited resection of the caudate lobe and those who underwent extended caudate lobectomy. Compared with 415 patients with HCC originating in other locations, the 20 patients with caudate lobe HCC showed significantly more intraoperative blood loss (P<.05), longer operation time (P<.0001), and more postoperative complications (P<.005). Intrahepatic recurrence was more frequent in the caudate lobe HCC compared with HCC originating in other locations (40% vs 17.6%; P<.05). There was a significantly poor survival rate in the postoperative patients with caudate HCC (25.9% vs 54.1% for five-year survival; P=.01). Intrahepatic multiple recurrences were frequently recognized in the patients with caudate lobe HCC, indicating no significance for extended caudate lobectomy.
Because of the relatively poor prognosis in patients with caudate lobe HCC, adjuvant therapy combined with surgical operation should be considered.
起源于尾状叶的肝细胞癌（HCC）较为罕见，因其独特的解剖位置，这类癌症的治疗颇具难度。
本回顾性研究评估了尾状叶HCC患者的手术结果。1990年至2002年期间，在我院接受肝切除的435例原发性HCC患者中，有20例起源于尾状叶。尾状叶肿瘤位于斯皮格尔叶的有3例，腔静脉旁部的有15例，尾状突的有2例。手术方式包括6例行尾状叶局限性切除术，14例行扩大尾状叶切除术。12例患者出现复发，其中8例为肝内多发复发，1例为腹膜播散，1例为淋巴结转移。
接受尾状叶局限性切除术与扩大尾状叶切除术的患者术后生存率无显著差异。与415例起源于其他部位的HCC患者相比，20例尾状叶HCC患者术中失血量显著更多（P<0.05），手术时间更长（P<0.0001），术后并发症更多（P<0.005）。与起源于其他部位的HCC相比，尾状叶HCC肝内复发更为频繁（40%对17.6%；P<0.05）。尾状叶HCC术后患者的生存率明显较差（五年生存率为25.9%对54.1%；P=0.01）。尾状叶HCC患者常出现肝内多发复发，提示扩大尾状叶切除术无显著意义。
鉴于尾状叶HCC患者预后相对较差，应考虑手术联合辅助治疗。
