Vitali Giulio C, Laurent Alexis, Terraz Sylvain, Majno Pietro, Buchs Nicolas C, Rubbia-Brandt Laura, Luciani Alain, Calderaro Julien, Morel Philippe, Azoulay Daniel, Toso Christian
Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
Department of Hepato-Biliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Créteil, France.
Surg Endosc. 2016 Jun;30(6):2301-7. doi: 10.1007/s00464-015-4295-6. Epub 2015 Nov 3.
Patients with single small hepatocellular carcinoma (HCC) can be managed by surgical resection or radio frequency ablation (RFA), with similar recurrence and survival rates. Recently, minimally invasive surgery (MIS) has been introduced in liver surgery, and the advantage/drawback balance between surgery and RFA needs reassessment.
Patients with Child-Pugh class A or B cirrhosis, and with single 1-3 cm HCC, undergoing MIS (laparoscopic or robot-assisted) or RFA from July 1998 to December 2012 were compared.
Overall, 45 patients underwent MIS, and 60 underwent RFA. Groups were not statistically different regarding type of underlying liver disease, HCC size, and AFP. However, RFA patients showed worse liver synthetic function with lower albumin and higher bilirubin serum levels, and higher ASA scores. Patients with HCC in segments 2-6 were more often treated by MIS. The incidence of complications was similar between groups (RFA: 6/60, 10 % vs. MIS: 5/45, 11 %, p = 0.854), and there was no measurable difference in the rate of procedure-related blood transfusions (RFA: 1/60, 1.7 % vs. MIS: 3/45, 6.7 %, p = 0.185). Local recurrence was only detected after RFA (11.7 %, p = 0.056, log-rank). Overall survival was higher in the MIS group (p = 0.042), with median survivals of 100 ± 13.5 versus 68 ± 15.9 months.
The present data need further validation. Selected patients with single ≤3-cm HCCs can be safely treated by MIS, without increased risk of perioperative complication, and with a lower risk of local recurrence. MIS should be especially favoured in patients with peripheral HCCs in segments 2-6, and/or when a histological assessment is desirable.
单个小肝细胞癌（HCC）患者可通过手术切除或射频消融（RFA）治疗，其复发率和生存率相似。近年来，微创外科手术（MIS）已引入肝脏外科领域，手术与RFA之间的利弊平衡需要重新评估。
对1998年7月至2012年12月期间接受MIS（腹腔镜或机器人辅助）或RFA治疗的Child-Pugh A或B级肝硬化且单个HCC直径为1-3 cm的患者进行比较。
总体而言，45例患者接受了MIS治疗，60例接受了RFA治疗。两组在基础肝病类型、HCC大小和甲胎蛋白方面无统计学差异。然而，RFA组患者的肝脏合成功能较差，血清白蛋白水平较低，胆红素水平较高，美国麻醉医师协会（ASA）评分也较高。2-6段HCC患者更常接受MIS治疗。两组并发症发生率相似（RFA组：6/60，10%；MIS组：5/45，11%，p = 0.854），与手术相关的输血率无显著差异（RFA组：1/60，1.7%；MIS组：3/45，6.7%，p = 0.185）。仅在RFA后检测到局部复发（11.7%，p = 0.056，对数秩检验）。MIS组的总生存率更高（p = 0.042），中位生存期分别为100±13.5个月和68±15.9个月。
目前的数据需要进一步验证。选定的单个≤3 cm HCC患者可通过MIS安全治疗，围手术期并发症风险不会增加，局部复发风险较低。对于2-6段外周HCC患者和/或需要进行组织学评估的患者，尤其应优先选择MIS。
