Kishi Yoji, Hasegawa Kiyoshi, Sugawara Yasuhiko, Kokudo Norihiro
Division of Surgery, Depatments of Hepatobiliary Pancreatic Surgery and Artificial Organ and Transplantation, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Int J Hepatol. 2011;2011:728103. doi: 10.4061/2011/728103. Epub 2011 Jun 23.
Currently, surgical resection is the treatment strategy offering the best long-term outcomes in patients with hepatocellular carcinoma (HCC). Especially for advanced HCC, surgical resection is the only strategy that is potentially curative, and the indications for surgical resection have expanded concomitantly with the technical advances in hepatectomy. A major problem is the high recurrence rate even after curative resection, especially in the remnant liver. Although repeat hepatectomy may prolong survival, the suitability may be limited due to multiple tumor recurrence or background liver cirrhosis. Multimodality approaches combining other local ablation or systemic therapy may help improve the prognosis. On the other hand, minimally invasive, or laparoscopic, hepatectomy has become popular over the last decade. Although the short-term safety and feasibility has been established, the long-term outcomes have not yet been adequately evaluated. Liver transplantation for HCC is also a possible option. Given the current situation of donor shortage, however, other local treatments should be considered as the first choice as long as liver function is maintained. Non-transplant treatment as a bridge to transplantation also helps in decreasing the risk of tumor progression or death during the waiting period. The optimal timing for transplantation after HCC recurrence remains to be investigated.
目前，手术切除是肝细胞癌（HCC）患者长期预后最佳的治疗策略。特别是对于晚期HCC，手术切除是唯一具有潜在治愈可能的策略，并且随着肝切除技术的进步，手术切除的适应证也相应扩大。一个主要问题是即使在根治性切除后复发率仍很高，尤其是在残余肝脏中。尽管再次肝切除可能延长生存期，但由于肿瘤多次复发或存在背景性肝硬化，其适用性可能受限。联合其他局部消融或全身治疗的多模式方法可能有助于改善预后。另一方面，微创或腹腔镜肝切除术在过去十年中已变得流行。虽然短期安全性和可行性已得到证实，但长期预后尚未得到充分评估。HCC的肝移植也是一种可能的选择。然而，鉴于目前供体短缺的情况，只要肝功能得以维持，其他局部治疗应被视为首选。作为移植桥梁的非移植治疗也有助于降低等待期间肿瘤进展或死亡的风险。HCC复发后移植的最佳时机仍有待研究。
