Department of Surgery, Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Surgery. 2012 Jan;151(1):55-60. doi: 10.1016/j.surg.2011.06.032. Epub 2011 Sep 22.
Little is known about outcomes and indications for living donor liver transplantation in patients with recurrent hepatocellular carcinoma after liver resection.
We analyzed retrospectively 176 patients with hepatocellular carcinoma who underwent living donor liver transplantation at our institute between February 1999 and December 2009. Among 128 of 176 patients with a history of pretreatment for hepatocellular carcinoma, 19 patients underwent radical liver resection. We compared patient characteristics, intraoperative blood loss, operative duration, and long-term outcomes including overall survival and recurrence rates between patients who had received hepatectomy, other pretreatments, and no pretreatments.
The surgical duration was significantly longer in patients with pretransplant hepatectomy than in those who had undergone other types of pretreatment (n = 109) or none (n = 48), whereas intraoperative blood loss did not differ among the 3 groups. Overall survival and recurrence rates did not significantly differ among the 3 groups. In patients with pretransplant hepatectomy, survival rates were significantly higher among patients who met the Kyoto criteria (≤10 tumors, all ≤5 cm in diameter and serum des-gamma-carboxy prothrombin levels ≤400 mAU/mL; n = 15) than those with values that exceeded the Kyoto criteria (n = 4) (5-year survival rates, 93% vs 25%, P = .005). Similarly, recurrence rates were significantly lower among patients meeting than exceeding the Kyoto criteria (5-year recurrence rates, 10% vs 67%, P = .011).
Patients with hepatocellular carcinoma recurrence after liver resection can safely undergo living donor liver transplantation. Long-term outcomes can be particularly favorable in patients who meet the Kyoto criteria.
对于肝癌切除术后复发的患者，活体肝移植的结果和适应证知之甚少。
我们回顾性分析了 1999 年 2 月至 2009 年 12 月在我院接受活体肝移植的 176 例肝癌患者。在 176 例有肝癌预处理史的患者中，128 例接受了根治性肝切除术。我们比较了接受肝切除术、其他预处理和无预处理的患者的患者特征、术中出血量、手术时间和包括总生存率和复发率在内的长期结果。
与接受其他类型预处理（n=109）或无预处理（n=48）的患者相比，接受肝移植前肝切除术的患者手术时间明显延长，而 3 组患者的术中出血量无差异。3 组患者的总生存率和复发率无显著差异。在接受肝移植前肝切除术的患者中，符合京都标准（≤10 个肿瘤，所有肿瘤直径均≤5cm，血清去γ-羧基凝血酶原水平≤400mAU/mL；n=15）的患者生存率明显高于超过京都标准（n=4）的患者（5 年生存率，93%比 25%，P=0.005）。同样，符合京都标准的患者复发率明显低于超过京都标准的患者（5 年复发率，10%比 67%，P=0.011）。
肝癌切除术后复发的患者可以安全地接受活体肝移植。符合京都标准的患者长期结果尤其良好。
