Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Clichy, France.
Langenbecks Arch Surg. 2012 Jun;397(5):681-95. doi: 10.1007/s00423-012-0911-2.
The purpose of this study is to review indications and results of surgical treatments of hepatocellular carcinoma (HCC). This tumor, which represents one of the most common malignancies worldwide, is characterized by its prominent development in patients with chronic liver disease (CLD). Liver transplantation (LT) is considered as the ideal treatment of limited HCC removing both tumor(s) and the pre-neoplasic underlying diseased liver. However, this treatment, which is not available in many countries, is restricted to patients with minimum risk of tumor recurrence under immunosuppression. The risk of recurrence is minimized in patients fulfilling the Milan criteria with a tendency to accept slight expansion of size in patients with favourable natural history and low AFP level. Increasing duration in the waiting list before LT leads several teams to use neoadjuvant therapies such as percutaneous ablation, TACE and liver resection. Liver resection in cirrhotic patients with good liver function remains the most available efficient treatment of patients with HCC. Better liver function assessment, understanding of the segmental liver anatomy with more accurate imaging studies and surgical technique refinements are the most important factors that have contributed to reduce mortality with an expecting 5 years survival of 70%. There is considerable interest in combined treatment associating resection and LT. Transplantable patients with good liver function should be considered for liver resection as primary therapy and for LT in case of tumor recurrence. This salvage strategy is refined using pathological analysis of the resected specimen which identifies histological pejorative factors allowing selecting patients who should transplanted before recurrence.
The improvement of survival in HCC patients after surgical treatment results from refinements in surgical technique and better identification of adverse prognostic factors.
本研究旨在回顾肝细胞癌 (HCC) 的外科治疗适应证和结果。这种肿瘤是全球最常见的恶性肿瘤之一，其特征是在慢性肝病 (CLD) 患者中显著发展。肝移植 (LT) 被认为是治疗局限性 HCC 的理想方法，可同时切除肿瘤和潜在的癌前病变肝脏。然而，这种治疗方法在许多国家都不可用，仅限于在免疫抑制下肿瘤复发风险最小的患者。满足米兰标准的患者复发风险最小，且倾向于接受具有良好自然史和低 AFP 水平的患者的肿瘤大小略微扩大。LT 前等待名单时间的延长促使许多团队使用新辅助治疗，如经皮消融、TACE 和肝切除术。对于肝功能良好的肝硬化患者，肝切除术仍然是 HCC 患者最有效的治疗方法。更好的肝功能评估、对分段肝脏解剖结构的理解以及更准确的影像学研究和手术技术的改进是降低死亡率的最重要因素，预计 5 年生存率为 70%。联合治疗（包括切除术和 LT）的应用受到广泛关注。具有良好肝功能的可移植患者应考虑作为原发性治疗进行肝切除术，并在肿瘤复发时进行 LT。这种挽救策略通过对切除标本的病理分析进行细化，确定了允许选择在复发前进行移植的组织学恶化因素。
手术治疗后 HCC 患者的生存率提高，这得益于手术技术的改进和对不良预后因素的更好识别。
