Department of General and Visceral Surgery, University Hospital Muenster, Waldeyerstrasse 1, Muenster, 48149, Germany.
World J Surg. 2010 Oct;34(10):2442-51. doi: 10.1007/s00268-010-0655-5.
In the case of hepatocellular carcinoma (HCC), underlying liver pathology may not only determine the feasibility of surgery but may also affect the postsurgical outcome. We report our experience after curative liver resection for HCC in patients with normal liver, liver fibrosis, and liver cirrhosis.
A total of 72 patients after liver resection with curative intention were analyzed. Histopathologic findings of tumor-unaffected liver tissue were used for retrospective classification: group A (normal liver); group B (liver fibrosis); group C (liver cirrhosis). The groups were compared for differences in short-term surgical results, total survival, and recurrence-free survival.
The rate of major complications was 34.7% and did not significantly differ among groups. The overall perioperative mortality rate was 9.7%, with one patient dying in group A and three patients dying in each of the other two groups. Including perioperative mortality, the median overall survival for the whole group was 37.3 months (95% confidence interval 29.3-45.2 months). The respective 1-, 2-, and 5-year survival rates for group A (n = 21) were 86%, 71%, and 50% and for group C (n = 24) 62%, 50%, and 17%. The overall survival of group B (n = 27) was intermediate (log-rank, P = 0.032). The respective recurrence-free survival rates were 76%, 42%, and 20% for group A and 39%, 13%, and 4% for group C, with group B being intermediate (log-rank, P = 0.016).
Our data demonstrate that liver resection in the presence of compensated liver cirrhosis is feasible but associated with a significantly impaired prognosis for overall and recurrence-free survival. The management of cirrhotic patients with compensated liver function and HCC therefore also requires the opportunity for transplantation.
在肝细胞癌（HCC）的情况下，潜在的肝脏病理学不仅可能决定手术的可行性，而且可能影响手术后的结果。我们报告了我们在正常肝脏、肝纤维化和肝硬化患者中进行根治性肝切除术后的经验。
对 72 例接受根治性肝切除术的患者进行了回顾性分析。使用肿瘤未受影响的肝组织的组织病理学发现进行回顾性分类：A 组（正常肝脏）；B 组（肝纤维化）；C 组（肝硬化）。比较各组之间短期手术结果、总生存和无复发生存的差异。
主要并发症发生率为 34.7%，各组之间无显著差异。总的围手术期死亡率为 9.7%，A 组 1 例死亡，其余两组各有 3 例死亡。包括围手术期死亡率在内，全组的中位总生存期为 37.3 个月（95%置信区间 29.3-45.2 个月）。A 组（n=21）的 1 年、2 年和 5 年生存率分别为 86%、71%和 50%，C 组（n=24）分别为 62%、50%和 17%。B 组（n=27）的总体生存率居中（对数秩检验，P=0.032）。A 组的无复发生存率分别为 76%、42%和 20%，C 组分别为 39%、13%和 4%，B 组居中（对数秩检验，P=0.016）。
我们的数据表明，代偿性肝硬化患者的肝切除术是可行的，但总体和无复发生存的预后显著受损。因此，对于肝功能代偿的肝硬化合并 HCC 患者的治疗也需要有移植的机会。
