Belghiti J, Fuks D
Department of HPB Surgery and Transplantation, Beaujon Hospital (Assistance Publique Hôpitaux de Paris), University Paris 7 Denis Diderot, Clichy, France.
Liver Cancer. 2012 Sep;1(2):71-82. doi: 10.1159/000342403.
Liver resection is the most available, efficient treatment for patients with hepatocellular carcinoma. Better liver function assessment, increased understanding of segmental liver anatomy using more accurate imaging studies, and surgical technical progress are the most important factors that have led to reduced mortality, with an expected 5 year survival of 70%. Impairment of liver function and the risk of tumor recurrence lead to consideration of liver transplantation (LT) as the ideal treatment for removal of the existing tumor and the preneoplastic underlying liver tissue. However, LT, which is not available in many countries, is restricted to patients with minimum risk of tumor recurrence under immunosuppression. Limited availability of grafts as well as the risk and the cost of the LT procedure has led to considerable interest in combined treatment involving resection and LT. An increasing amount of evidence has shown that initial liver resection in transplantable patients with a single limited tumor and good liver function is a valid indication. Histological analysis of specimens allows identification of the subgroup of patients who could benefit from follow-up with LT in case of recurrence.
肝切除术是肝细胞癌患者最可行、有效的治疗方法。更好的肝功能评估、通过更精确的影像学研究对肝段解剖结构的深入了解以及手术技术的进步是导致死亡率降低的最重要因素，预计5年生存率为70%。肝功能损害和肿瘤复发风险促使人们考虑将肝移植（LT）作为切除现有肿瘤和癌前肝脏组织的理想治疗方法。然而，肝移植在许多国家无法开展，仅限于免疫抑制下肿瘤复发风险最低的患者。肝移植供体有限以及肝移植手术的风险和成本引发了人们对肝切除与肝移植联合治疗的浓厚兴趣。越来越多的证据表明，对于单个局限性肿瘤且肝功能良好的可移植患者，初始肝切除术是一种有效的治疗指征。对标本进行组织学分析有助于确定复发时可从肝移植随访中获益的患者亚组。
