Chok Kenneth Siu Ho, Chan See Ching, Poon Ronnie Tung Ping, Fan Sheung Tat, Lo Chung Mau
Department of Surgery, University of Hong Kong, Hong Kong, China.
ANZ J Surg. 2012 Jan-Feb;82(1-2):63-7. doi: 10.1111/j.1445-2197.2011.05931.x. Epub 2011 Dec 20.
In management of intrahepatic recurrence of hepatocellular carcinoma (HCC), controversy exists over the efficacy of re-resection for patients with preserved liver function. This study aimed to determine the long-term outcomes of re-resection in these patients.
Prospectively collected data of 47 patients having re-resection (Group R) with curative intent for metachronous primary HCC between December 1989 and December 2007 were compared with those of 863 patients having primary resection (Group P) in the same period. There was no overlap of patient. All patients had gross tumour-free resection margin.
The two groups had comparable demographics. Group R had a median age of 58 years (range, 48-67 years), and had almost all patients belonging to Child-Pugh class A (46/47). Median blood loss was 0.66 L (range, 0.3-1.28 L) for Group P and 0.37 L (range, 0.13-0.92 L) for Group R. Both groups had median blood transfusion rate at 0. Median operative time was 365 min (range, 240-490 min) for Group P and 270 min (range, 193-360 min) for Group R. Group R had significantly fewer tumour nodules and the only one operative death. Median follow-up was 41 months for Group P and 37 months for Group R (P= 0.133). The two groups displayed no significant differences in disease-free survival and overall survival. Univariate analysis showed that re-resection was not a significant risk factor in overall survival.
Re-resection for metachronous primary HCC for patients with preserved liver function can achieve favourable survival outcome.
在肝细胞癌（HCC）肝内复发的管理中，对于肝功能良好的患者再次手术切除的疗效存在争议。本研究旨在确定这些患者再次手术切除的长期结果。
将1989年12月至2007年12月期间47例有治愈意向的异时性原发性HCC患者再次手术切除（R组）的前瞻性收集数据与同期863例接受初次手术切除（P组）的患者数据进行比较。患者无重叠。所有患者切缘均无肉眼可见肿瘤。
两组患者人口统计学特征具有可比性。R组患者中位年龄为58岁（范围48 - 67岁），几乎所有患者属于Child-Pugh A级（46/47）。P组中位失血量为0.66L（范围0.3 - 1.28L），R组为0.37L（范围0.13 - 0.92L）。两组中位输血率均为0。P组中位手术时间为365分钟（范围240 - 490分钟），R组为270分钟（范围193 - 360分钟）。R组肿瘤结节明显较少，且仅有1例手术死亡。P组中位随访时间为41个月，R组为37个月（P = 0.133）。两组在无病生存期和总生存期方面无显著差异。单因素分析显示再次手术切除不是总生存期的显著危险因素。
对于肝功能良好的异时性原发性HCC患者，再次手术切除可取得良好的生存结果。
