大肝细胞癌（≥10 cm）切除术：独特的西方视角。

Resection of large hepatocellular carcinoma (≥10 cm): a unique western perspective.

机构信息

Division of Surgical Oncology, Department of Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA.

出版信息

J Surg Oncol. 2013 Feb;107(2):111-7. doi: 10.1002/jso.23246. Epub 2012 Aug 17.

DOI:10.1002/jso.23246

PMID:22903563

Abstract

BACKGROUND AND OBJECTIVES

Few Western centers have surgically treated a high volume of large hepatocellular carcinoma 10 cm or more in diameter. The study aim was to analyze a large Western cohort of these patients, and to present our outcomes in the context of the more extensive Eastern experience.

METHODS

We retrospectively reviewed all patients at our center receiving partial hepatectomy from January 1992 to August 2010, and analyzed a cohort with hepatocellular carcinoma ≥10 cm in diameter.

RESULTS

One hundred thirty patients comprised the cohort. One hundred three (79.2%) of the patients received major anatomic resections, and 23 (17.7%) patients underwent tumor thrombectomy as an adjunct procedure. Perioperative mortality was observed in 9 (6.9%) of cases, but from January 2002 onward, only 2 (2.3%) of the 86 resections performed resulted in a mortality. The survival rate at 1, 3, and 5 years was 56.9%, 30.3%, and 18.8%, respectively; the median survival was 17.0 months. The subgroup of 39 patients without gross vascular invasion and satellite nodules achieved a median survival of 40.3 months.

CONCLUSIONS

Resection of large hepatocellular carcinoma can be done with safety at a large Western center, and a subgroup of patients will achieve long-term survival.

摘要

背景与目的

少数西方中心对直径大于 10cm 的大肝细胞癌进行了大量的手术治疗。本研究旨在分析一个大型的西方患者队列，并结合更广泛的东方经验来展示我们的结果。

方法

我们回顾性分析了 1992 年 1 月至 2010 年 8 月在我们中心接受部分肝切除术的所有患者，并分析了一组肝细胞癌直径≥10cm 的患者。

结果

该队列包括 130 例患者。103 例（79.2%）患者接受了主要解剖性切除术，23 例（17.7%）患者接受了肿瘤血栓切除术作为辅助治疗。9 例（6.9%）发生围手术期死亡，但自 2002 年 1 月以来，86 例切除术中仅 2 例（2.3%）导致死亡。1、3 和 5 年的生存率分别为 56.9%、30.3%和 18.8%；中位生存时间为 17.0 个月。无明显血管侵犯和卫星结节的 39 例患者亚组的中位生存时间为 40.3 个月。