尾状叶单发肝细胞癌行肝切除术患者的预后。

Prognosis of patients undergoing hepatectomy for solitary hepatocellular carcinoma originating in the caudate lobe.

机构信息

Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan.

出版信息

Surgery. 2011 Nov;150(5):959-67. doi: 10.1016/j.surg.2011.03.005. Epub 2011 Jul 23.

DOI:10.1016/j.surg.2011.03.005

PMID:21783218

Abstract

BACKGROUND

Operative and nonoperative treatment for hepatocellular carcinoma (HCC) originating in the caudate lobe is regarded as challenging because of its deep location in the liver and possibly worse prognosis than HCC in other sites in the liver. The objective of this study is to investigate the clinicopathologic factors and survival of patients who underwent hepatectomy for solitary HCC originating in the caudate lobe.

METHODS

A retrospective review of 783 patients who underwent curative hepatectomy for solitary HCC between 1988 was performed. Clinicopathologic factors and survival rate of 46 (5.9%) patients with HCC originating in the caudate lobe were compared with those of 737 (94%) patients with HCC arising in other sites.

RESULTS

The clinical backgrounds of patients with HCC in the caudate lobe and in other sites were comparable. Hepatectomy for HCC in the caudate lobe was associated with greater operative time and blood loss than for HCC in other sites of the liver. Pathologically, HCC in the caudate lobe was associated with less frequent intrahepatic metastasis, lesser operative margins, and more frequent tumor exposure than HCC in other sites. Overall and disease-free 5-year survival rates of the 46 patients with solitary HCC in the caudate lobe were 76% and 45%, respectively; no significant difference was observed in the overall or disease-free survival rates between the 2 groups (P = .07 and P = .77, respectively). Resection of HCC in the paracaval portion of the caudate lobe (n = 27) was associated with more frequent anatomic resection, greater operative time and blood loss, and a lesser operative margin than HCC in the Spiegel lobe or caudate process (n = 19).

CONCLUSION

Resection for HCC in the caudate lobe, especially in the paracaval portion, remains technically demanding. The prognosis of patients with solitary HCC in the caudate lobe, however, was as good as that of patients with solitary HCC in other sites in the liver.

摘要

背景

由于位于肝脏深部，且预后可能比肝脏其他部位的 HCC 更差，因此对于起源于尾状叶的肝细胞癌 (HCC) 的手术和非手术治疗被认为具有挑战性。本研究旨在探讨接受肝切除术治疗单发尾状叶 HCC 的患者的临床病理因素和生存情况。

方法

回顾性分析 1988 年期间接受根治性肝切除术治疗单发 HCC 的 783 例患者。比较 46 例起源于尾状叶 HCC 患者与 737 例起源于肝脏其他部位 HCC 患者的临床病理因素和生存率。

结果

尾状叶 HCC 患者与其他部位 HCC 患者的临床背景相当。与其他部位的 HCC 相比，尾状叶 HCC 的肝切除术手术时间和出血量更大。从病理学角度来看，尾状叶 HCC 肝内转移较少，手术切缘较小，肿瘤暴露较其他部位 HCC 更常见。46 例单发尾状叶 HCC 患者的总体和无病 5 年生存率分别为 76%和 45%；两组之间的总体生存率或无病生存率无显著差异（P =.07 和 P =.77）。尾状叶旁叶部 HCC（n = 27）的解剖性切除术较常见，手术时间和出血量较大，手术切缘较小，而尾状叶 Spiegels 叶或尾状突部 HCC（n = 19）则相反。