Wong Tiffany Cho Lam, Cheung Tan To, Chok Kenneth S H, Chan Albert C Y, Dai Wing Chiu, Chan See Ching, Poon Ronnie T P, Lo Chung Mau
Department of Surgery Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong S.A.R, China.
World J Surg. 2014 Sep;38(9):2386-94. doi: 10.1007/s00268-014-2601-4.
The extent of hepatectomy for solitary hepatocellular carcinoma (HCC) <5 cm is controversial.
This is a retrospective review of patients with solitary HCC <5 cm, who underwent liver resection in a tertiary referral centre in Hong Kong between January 1989 and December 2009. Baseline demographics, liver function, peri-operative outcomes, and overall survival were compared.
A total of 348 cirrhotic patients with a solitary HCC <5 cm underwent either major hepatectomy (n = 93) or minor hepatectomy (n = 255). Child-Pugh status did not differ, 98.9 vs. 96.1 % (p = 0.319); all patients who underwent major and minor hepatectomy were classified as Child-Pugh status A. Patients who underwent major hepatectomy had a larger median tumor size (4.0 vs. 2.5 cm, p < 0.001) and they also had more advanced stage of disease (stage I/II/IIIa: 10.8/55.9/33.3 vs. 26.7/52.9/20.4 %, p = 0.002). Median operative time for major hepatectomy was significantly longer (415 vs. 248 min, p < 0.001) and entailed greater blood loss (0.9 vs. 0.5 l, p < 0.001). Despite larger tumor size and more advanced stage of disease in the major hepatectomy group, hospital mortality (5.4 vs. 2.0 %, p = 0.185), complication rates (30.1 vs. 23.1 %, p = 0.234), and transfusion rate (10.8 vs. 11.4 %, p = 0.862) were the same between the two groups. Overall survival was significantly better for those who underwent major hepatectomy, with a median survival of 147.5 vs. 92.1 months (p = 0.043), and they had a better 5- and 10-year disease-free survival rate (57.3 vs. 40.2, 38.1 vs. 18.9 %, p = 0.003). In subgroup analysis, the 10-year survival for patients with stage II HCC and tumor <5 cm was 68.6 vs. 36.6 % in those who received minor hepatectomy alone (p = 0.027).
Major hepatectomy provided better long-term survival benefit in patients with HCC <5 cm, particularly in those with stage II disease.
对于直径小于5cm的孤立性肝细胞癌（HCC），肝切除范围存在争议。
这是一项对1989年1月至2009年12月期间在香港一家三级转诊中心接受肝切除的直径小于5cm的孤立性HCC患者的回顾性研究。比较了患者的基线人口统计学资料、肝功能、围手术期结局和总生存期。
共有348例直径小于5cm的肝硬化孤立性HCC患者接受了大肝切除术（n = 93）或小肝切除术（n = 255）。Child-Pugh分级情况无差异，分别为98.9%和96.1%（p = 0.319）；所有接受大肝切除术和小肝切除术的患者均被归类为Child-Pugh A级。接受大肝切除术的患者肿瘤中位数更大（4.0cm对2.5cm，p < 0.001），且疾病分期更晚（I/II/IIIa期：10.8/55.9/33.3%对26.7/52.9/20.4%，p = 0.002）。大肝切除术的中位手术时间明显更长（415分钟对248分钟，p < 0.001），出血量也更大（0.9L对0.5L，p < 0.001）。尽管大肝切除术组的肿瘤更大且疾病分期更晚，但两组的医院死亡率（5.4%对2.0%，p = 0.185）、并发症发生率（30.1%对23.1%，p = 0.234）和输血率（10.8%对11.4%，p = 0.862）相同。接受大肝切除术患者的总生存期明显更好，中位生存期为147.5个月对92.1个月（p = 0.043），且5年和10年无病生存率更高（57.3%对40.2%，38.1%对18.9%，p = 0.003）。在亚组分析中，II期HCC且肿瘤<5cm患者中，单纯接受小肝切除术者的10年生存率为36.6%，而接受大肝切除术者为68.6%（p = 0.027）。
对于直径小于5cm的HCC患者，大肝切除术能提供更好的长期生存获益，尤其是对于II期疾病患者。
