Hoyer D P, Paul A, Lauenstein T, Bockisch A, Treckmann J-W, Gerken G, Mathé Z
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Essen, Deutschland.
Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen, Deutschland.
Zentralbl Chir. 2016 Aug;141(4):390-6. doi: 10.1055/s-0032-1328569. Epub 2013 Jul 11.
The utilisation of interventional ablation procedures in the context of bridging and downstaging plans for hepatocellular carcinomas before liver transplantation is increasing. The aim of the present study was to summarise current data for the application of bridging and downstaging procedures before liver transplantation.
The present study is based on an extensive investigation of the literature in PubMed. RESULTS of controlled trials, cohort studies, meta-analyses and reviews were included.
Recommendations for the usage of bridging procedures for hepatocellular carcinomas within the Milan criteria and an expected waiting time of more than 6 months until transplantation depend on the size of the lesions and have a low level of evidence. After successful downstaging of hepatocellular carcinomas beyond the Milan criteria into the range of the Milan criteria liver transplantation is recommended with a low level of evidence, as well.
Randomised controlled trials, clearly proving the success of bridging and downstaging procedures, are not available at the time and are not awaited for ethical reasons. Due to the uncomplicated application and low risk for therapy-associated complications, interventional procedures for bridging and downstaging are accepted and recommended.
在肝细胞癌肝移植前的桥接和降期计划中，介入消融手术的应用日益增加。本研究的目的是总结肝移植前桥接和降期手术应用的当前数据。
本研究基于对PubMed文献的广泛调查。纳入了对照试验、队列研究、荟萃分析和综述的结果。
对于符合米兰标准且预计等待移植时间超过6个月的肝细胞癌，桥接手术的使用建议取决于病变大小，证据水平较低。对于超出米兰标准的肝细胞癌成功降期至米兰标准范围内后，也建议进行肝移植，证据水平较低。
目前尚无明确证明桥接和降期手术成功的随机对照试验，且出于伦理原因也不期待有此类试验。由于应用简单且治疗相关并发症风险低，桥接和降期的介入手术被接受并推荐。
