Kluger Michael D, Cherqui Daniel
Department of Surgery, New York Presbyterian Hospital, New York, NY 10065, USA.
Recent Results Cancer Res. 2013;190:111-26. doi: 10.1007/978-3-642-16037-0_8.
The current treatment of HCC is truly multidisciplinary. Notwithstanding, surgical management remains the gold standard which other therapies are compared to. Operative management is divided into transplantation and resection; the latter is further subdivided among open and laparoscopic approaches. Resection has become safer, remains superior to locoregional treatments, and can be a life-prolonging bridge to transplantation. The decision to pursue laparoscopic resection for HCC is driven by safety and a view toward the long-term management of both the malignancy and the underlying liver disease. For patients with a solitary HCC <5 cm in segments 2, 3, 4b, 5, and 6, no evidence of extrahepatic tumor burden, compensated liver disease, and the absence of significant portal hypertension, laparoscopy has an important role. Under these circumstances, resection can be performed with reduced mortality and morbidity and equivalent oncologic outcomes, disease-free survival, and overall survival when compared with similarly selected cirrhotic patients undergoing open resection. Blood loss and transfusion requirements are low, and laparoscopy itself does not expose the patient to complications and does not increase the risk of cancer recurrence or dissemination. Finally, because HCC recurrence remains high in the cirrhotic liver, treatment following surgical resection mandates routine surveillance and treatment by locoregional therapy, reresection, or transplantation as required-the latter two of which are facilitated by an initial laparoscopic resection.
目前肝癌的治疗确实是多学科的。尽管如此，手术治疗仍然是其他治疗方法所参照的金标准。手术治疗分为肝移植和肝切除；后者又进一步细分为开放手术和腹腔镜手术。肝切除已变得更加安全，仍然优于局部区域治疗，并且可以成为通向肝移植的延长生命的桥梁。决定对肝癌进行腹腔镜肝切除是出于安全性考虑以及对恶性肿瘤和潜在肝脏疾病的长期管理。对于位于第2、3、4b、5和6段的直径<5 cm的孤立性肝癌患者，无肝外肿瘤负荷证据、肝功能代偿良好且无明显门静脉高压，腹腔镜手术具有重要作用。在这些情况下，与接受开放手术的类似选择的肝硬化患者相比，腹腔镜肝切除可以降低死亡率和发病率，并且在肿瘤学结局、无病生存率和总生存率方面相当。失血量和输血需求较低，并且腹腔镜手术本身不会使患者面临并发症风险，也不会增加癌症复发或播散的风险。最后，由于肝硬化肝脏中肝癌复发率仍然很高，手术切除后的治疗需要进行常规监测，并根据需要采用局部区域治疗、再次切除或肝移植进行治疗——后两者因最初的腹腔镜切除而更易实施。
