Chang Chun-Ming, Wei Chang-Kuo, Lee Cheng-Hong, Tseng Kuo-Chih, Lin Chih-Wen, Yin Wen-Yao
Department of General Surgery, Buddhist Dalin Tzu Chi General Hsopital , Chi-Yi, Taiwan.
Hepatogastroenterology. 2012 Mar-Apr;59(114):492-5. doi: 10.5754/hge11361.
BACKGROUND/AIMS: Multiple hepatic vessels and portal vessels are distributed in the central segments of the liver (segments IV, V and VIII). Due to its anatomical complexity, in centrally-located hepatocellular carcinoma (cHCC) it is theoretically not easy to reach a wide margin, as it is in non-central hepatocellular carcinoma (ncHCC) (segments II, III, VII and VIII). We compared their outcomes to see if cHCC has an inferior result than ncHCC.
From August 2000 to July 2008, 213 HCC patients received curative-intended resection. Sixty-nine cHCC (group A) and 64 ncHCC (group B) received trisegmentectomy (include mesohepatectomy), bi-segmentectomy, mono-segmentectomy or subsegmentectomy. The outcomes were retrospectively analyzed.
The in-hospital mortality was 0% and 3.12% in groups A and B, respectively (p=0.55). The morbidity was 27.5% and 28.1% in groups A and B, respectively (p=0.23). The 1- and 3-year disease-free survival were 68%, 50% and 62%, 33% in groups A and B, respectively (p=0.39). The 1- and 3-year overall survival rates were 83%, 75% and 89%, 70% in groups A and B, respectively (p=0.91). Tumor size and numbers were significant factors for disease-free and overall survival.
cHCC treated by partial hepatectomy and mesohepatectomy has a comparable result to ncHCC. Mesohepatectomy is needed only in some selected patients.
背景/目的：多条肝血管和门静脉分布于肝脏中央段（第IV、V和VIII段）。由于其解剖结构复杂，理论上位于肝脏中央的肝细胞癌（cHCC）与非中央肝细胞癌（ncHCC，位于第II、III、VII和VIII段）相比，难以获得较宽的手术切缘。我们比较了两者的治疗结果，以了解cHCC的治疗效果是否劣于ncHCC。
2000年8月至2008年7月，213例肝癌患者接受了根治性切除手术。69例cHCC患者（A组）和64例ncHCC患者（B组）接受了三段肝切除术（包括肝中叶切除术）、二段肝切除术、一段肝切除术或亚段肝切除术。对治疗结果进行回顾性分析。
A组和B组的住院死亡率分别为0%和3.12%（p = 0.55）。A组和B组的并发症发生率分别为27.5%和28.1%（p = 0.23）。A组和B组的1年和3年无病生存率分别为68%、50%和62%、33%（p = 0.39）。A组和B组的1年和3年总生存率分别为83%、75%和89%、70%（p = 0.91）。肿瘤大小和数量是影响无病生存率和总生存率的重要因素。
通过肝部分切除术和肝中叶切除术治疗的cHCC与ncHCC的治疗效果相当。仅在部分特定患者中需要进行肝中叶切除术。
