Benzoni Enrico, Lorenzin Dario, Favero Alessandro, Adani Gianluigi, Baccarani Umberto, Molaro Roberta, Zompicchiatti Aron, Saccomano Enrico, Avellini Claudio, Bresadola Fabrizio, Uzzau Alessandro
Department of Surgery, School of Medicine, University of Udine, Udine, Italy.
Tumori. 2007 May-Jun;93(3):264-8. doi: 10.1177/030089160709300306.
Hepatocellular carcinoma (Hcc) is the third most common cause of cancer death. The aim of this study is to examine the factors associated with improved prognosis in Hcc after liver resection.
From September 1989 to March 2005, 134 consecutive patients had liver resection for Hcc on cirrhosis at our department. We performed 54 major liver resections and 80 limited resections. All patients enrolled in the study were followed-up three times during the first year after resection and twice the next years.
In-hospital mortality rate was 7.4%, about 50% of these cases were Child-Pugh B patients. Morbidity rate was 47.7%, caused by the rising of ascites, temporary liver impairment function, biliary fistula, hepatic abscess, hemoperitoneum and pleural effusion. Overall survival resulted to be influenced by etiology (P = 0.03), underlying liver disease, in particular Child A vs BC (P = 0.04), Endmondson-Steiner grading (P = 0.01), the absence of a capsule (P = 0.004), the presence of more than one lesion (P = 0.02), lesion's size over 5 cm (P = 0.04), Pringle maneuver length over than 20 minutes (P = 0.03), an amount of resected liver volume lesser than 50% of total liver volume (P = 0.03), and the relapse of Hcc (P= 0.01).
The treatment of hepatocellular carcinoma should be both the most radical to obtain the best outcome and to reduce the recurrence's rate, and the most suitable according to the patient's condition, lesion's characteristics and underlying liver disease: because of the large number of factors affecting the outcome of Hcc, unfortunately, we are still far from an agreement upon a group of criteria useful to select the best candidates for liver resection.
肝细胞癌（Hcc）是癌症死亡的第三大常见原因。本研究的目的是探讨肝切除术后肝细胞癌预后改善的相关因素。
1989年9月至2005年3月，我科连续134例因肝硬化合并肝细胞癌接受肝切除术的患者。我们进行了54例大肝切除术和80例局限性切除术。所有纳入研究的患者在切除术后的第一年接受了三次随访，次年接受了两次随访。
住院死亡率为7.4%，其中约50%为Child-Pugh B级患者。发病率为47.7%，由腹水增加、暂时性肝功能损害、胆瘘、肝脓肿、腹腔内出血和胸腔积液引起。总体生存率受病因（P = 0.03）、潜在肝脏疾病（特别是Child A与BC级，P = 0.04）、Edmondson-Steiner分级（P = 0.01）、无包膜（P = 0.004）、存在多个病灶（P = 0.02）、病灶大小超过5 cm（P = 0.04）、Pringle手法时间超过20分钟（P = 0.03）、切除肝体积小于全肝体积的50%（P = 0.03）以及肝细胞癌复发（P = 0.01）影响。
肝细胞癌的治疗既要最彻底以获得最佳疗效并降低复发率，又要根据患者病情、病灶特征和潜在肝脏疾病选择最合适的治疗方法：由于影响肝细胞癌预后的因素众多，不幸的是，我们在一组有助于选择肝切除最佳候选者的标准上仍远未达成共识。
