Yu Weibo, Rong Weiqi, Wang Liming, Wu Fan, Xu Quan, Wu Jianxiong
Abdominal Surgery Department, Cancer Institute and Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, NO. 17 Panjiayuannanli, Chaoyang District, Beijing, 100021, People's Republic of China.
World J Surg. 2014 Jul;38(7):1777-85. doi: 10.1007/s00268-013-2429-3.
Hepatectomy with exposure of tumor surface (a special type of R1 resection) provides a chance of cure for selected patients with centrally located hepatocellular carcinoma (HCC) that is adherent to or compresses major vessels. However, the operative indications, safety, and patient outcomes are not well defined.
We performed hepatectomy for removal of complex centrally located HCC using a selective and dynamic region-specific vascular occlusion technique. Between May 2006 and March 2012, a total of 118 patients underwent resection with exposure of tumor surface (exposure group) and 169 underwent conventional hepatectomy (without exposure of the tumor and vascular surface). The short- and long-term outcomes of patients were evaluated and compared.
The postoperative recovery of liver function was comparable between the two groups. Bile leakage occurred in five patients, all in the exposure group. The 1-, 3-, and 5-year recurrence-free survival rates were 74.4, 45.6, and 30.1 % in the exposure group and 80.9, 57.2, and 31.7 % in the control group (p = 0.041). Corresponding overall survival rates were 92.3, 70.3, and 44.9 % in the exposure group and 97.8, 81.4, and 53.1 % in the control group (p = 0.094).
Hepatectomy with exposure of tumor surface is technically demanding, but can be performed safely. It is also associated with a risk of tumor recurrence. Multidisciplinary combined therapy would be the solution and can contribute to improve overall survival.
切除肿瘤表面的肝切除术（一种特殊类型的R1切除）为部分中央型肝细胞癌（HCC）患者提供了治愈的机会，这些患者的肿瘤与主要血管粘连或压迫主要血管。然而，手术适应症、安全性和患者预后尚未明确。
我们采用选择性和动态区域特异性血管阻断技术，对复杂的中央型HCC进行肝切除术。2006年5月至2012年3月，共有118例患者接受了切除肿瘤表面的肝切除术（暴露组），169例患者接受了传统肝切除术（未暴露肿瘤和血管表面）。对患者的短期和长期预后进行评估和比较。
两组患者术后肝功能恢复情况相当。5例患者发生胆漏，均在暴露组。暴露组1年、3年和5年无复发生存率分别为74.4%、45.6%和30.1%，对照组分别为80.9%、57.2%和31.7%（p = 0.041）。相应的总生存率在暴露组分别为92.3%、70.3%和44.9%，对照组分别为97.8%、81.4%和53.1%（p = 0.094）。
切除肿瘤表面的肝切除术技术要求高，但可以安全进行。它也与肿瘤复发风险相关。多学科联合治疗可能是解决办法，有助于提高总生存率。
