Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
J Surg Res. 2010 May 1;160(1):81-9. doi: 10.1016/j.jss.2009.01.021. Epub 2009 Feb 21.
Anatomic resection of the liver in patients with hepatocellular carcinoma (HCC) is generally recommended. Several previous reports have described the potential superiority of anatomic resection. However, no clear evidence of long-term survival or other advantages compared with those achieved with limited resection exist. We evaluated the oncologic outcomes of nonanatomic resection performed as a primary treatment for small (<or=4 cm) and single HCC in patients with well-preserved liver function (Child-Pugh class A).
From March 1998 to January 2005, 353 consecutive patients underwent resection of HCC. Among them, 167 patients with single and small (<or=4 cm) HCC and well-preserved liver function (Child-Pugh class A) were selected. Twenty-one patients (12.6%) underwent nonanatomic resection (Group NA) and 146 (82.4%) underwent anatomic resection (Group A). Patient factors, tumor factors, surgery factors, disease-free survival, and recurrence patterns were compared between the two groups.
There were no significantly different preoperative clinical characteristics between the two groups (Group NA versus Group A). Only the resection margin width (0.8 +/- 0.6 cm versus 2.0 +/- 1.4 cm, P < 0.001) and operative time (211.9 +/- 72.9 min versus 251 +/- 80.0 min, P = 0.036) were significantly different between the two groups. There was no difference in disease-free survival between the two groups, and platelet counts of less than 100,000/microL (P = 0.038), satellite nodules (P = 0.0164), and microscopic portal vein invasion (P < 0.001) were significant prognostic factors predicting disease-free survival in univariate analysis. Subsequent Cox-proportional hazards models revealed that both microscopic portal vein invasion (Exp {beta} = 3.281, P < 0.001) and platelet counts of less than 100,000/microL (Exp {beta} = 1.913, P = 0.012) adversely affected disease-free survival. Nonanatomic resection did not have adverse effects on early recurrence compared to anatomic resection (P = 0.805).
Our study showed that nonanatomic resection has no adverse effects on the oncologic outcomes of single and small (<or=4 cm) HCC in patients with well-preserved liver function (Child-Pugh class A).
在肝细胞癌（HCC）患者中，一般推荐进行解剖性肝切除术。有几项先前的报告描述了解剖性切除术的潜在优势。然而，与局限性肝切除术相比，目前尚不存在长期生存或其他优势的明确证据。我们评估了在肝功能良好（Child-Pugh 分级 A）的患者中，作为原发性治疗方法，对小（≤4cm）单发 HCC 行非解剖性切除术的肿瘤学结果。
1998 年 3 月至 2005 年 1 月，连续有 353 例患者接受了 HCC 切除术。其中，选择了 167 例肝功能良好（Child-Pugh 分级 A）的单发和小（≤4cm） HCC 患者。21 例（12.6%）患者行非解剖性切除术（NA 组），146 例（82.4%）患者行解剖性切除术（A 组）。比较两组患者的术前因素、肿瘤因素、手术因素、无病生存率和复发模式。
两组患者术前临床特征无显著差异（NA 组与 A 组）。仅在切缘宽度（0.8±0.6cm 与 2.0±1.4cm，P＜0.001）和手术时间（211.9±72.9min 与 251±80.0min，P=0.036）方面两组有显著差异。两组患者无病生存率无差异，血小板计数＜10 万/μL（P=0.038）、卫星结节（P=0.0164）和微血管门静脉侵犯（P＜0.001）是单因素分析中无病生存率的显著预后因素。随后的 Cox 比例风险模型显示，微血管门静脉侵犯（Expβ=3.281，P＜0.001）和血小板计数＜10 万/μL（Expβ=1.913，P=0.012）均对无病生存率有不良影响。与解剖性切除术相比，非解剖性切除术对早期复发没有不利影响（P=0.805）。
我们的研究表明，对于肝功能良好（Child-Pugh 分级 A）的单发和小（≤4cm） HCC 患者，非解剖性切除术对肿瘤学结果无不良影响。
