Yamashita Yo-ichi, Taketomi Akinobu, Itoh Shinji, Kitagawa Dai, Kayashima Hiroto, Harimoto Norifumi, Tsujita Eiji, Kuroda Yosuke, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Am Coll Surg. 2007 Jul;205(1):19-26. doi: 10.1016/j.jamcollsurg.2007.01.069.
Recently, anatomic resection has been, in theory, considered preferable for eradicating portal venous tumor extension and intrahepatic metastasis in hepatocellular carcinoma (HCC). We have reported the effectiveness of limited hepatic resection for cirrhotic patients with HCC.
A retrospective study was carried out in 321 patients who underwent curative hepatic resection (anatomic resection, n=201; limited resection, n=120) as the initial treatment for solitary HCC<5 cm in our institution in the period 1985 to 2004 (median followup period 5.1 years).
Anatomic resection did not influence overall and recurrence-free survival rates after hepatic resection. In the liver damage A group (n=215), both 5-year overall and recurrence-free survival rates in the anatomic resection group were considerably better than those in the limited resection group (87% versus 76%, p=0.02, and 63% versus 35%, p<0.01, respectively). In the liver damage B group (n=106), both 5-year overall and recurrence-free survival rates in the anatomic resection group were substantially worse than those in the limited resection group (48% versus 72%, p<0.01, and 28% versus 43%, p=0.01, respectively). The results of multivariate analysis revealed that anatomic resection was a notably poor factor in promoting recurrence-free survival in patients with liver damage B.
Anatomic resection should be recommended for noncirrhotic patients (liver damage A) with HCC. Longterm results of limited hepatic resection proved its validity for cirrhotic patients (liver damage B) with HCC.
近来，理论上认为解剖性切除对于根除肝细胞癌（HCC）的门静脉肿瘤浸润及肝内转移更为可取。我们已经报道了局限性肝切除对肝硬化HCC患者的有效性。
对1985年至2004年期间在我院接受根治性肝切除（解剖性切除，n = 201；局限性切除，n = 120）作为直径<5 cm的孤立性HCC初始治疗的321例患者进行了一项回顾性研究（中位随访期5.1年）。
解剖性切除对肝切除术后的总生存率和无复发生存率无影响。在肝损害A组（n = 215）中，解剖性切除组的5年总生存率和无复发生存率均显著优于局限性切除组（分别为87%对76%，p = 0.02；63%对35%，p<0.01）。在肝损害B组（n = 106）中，解剖性切除组的5年总生存率和无复发生存率均显著低于局限性切除组（分别为48%对72%，p<0.01；28%对43%，p = 0.01）。多因素分析结果显示，解剖性切除是肝损害B患者无复发生存的一个显著不良因素。
对于非肝硬化的HCC患者（肝损害A），应推荐解剖性切除。局限性肝切除的长期结果证明了其对肝硬化HCC患者（肝损害B）的有效性。
