Hao Shenghua, Chen Shaofei, Yang Xiangwu, Wan Chidan
Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
Department of General Surgery, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, China.
Surg Today. 2016 Nov;46(11):1290-5. doi: 10.1007/s00595-016-1316-6. Epub 2016 Mar 2.
To evaluate the impact of intermittent portal clamping (IPC) during surgery on the early recurrence of hepatocellular carcinoma (HCC).
The subjects of this retrospective study were 266 patients who underwent curative liver resection for HCC. The patients were grouped as follows: an intermittent portal clamping (IPC) group, n = 78; a continuous portal clamping (CPC) group, n = 128; and a non-portal clamping (NPC) group, n = 60.
The median recurrence-free interval within 2 years of follow-up was significantly shorter in the IPC group (14.2 ± 4.6 months) than in the CPC group (18.0 ± 4.8 months, P = 0.008) or the NPC group (19.04 ± 4.1 months, P = 0.023). Moreover, 2-year recurrence-free survival was much lower in the IPC group than in the CPC group (63.6 vs. 75.8 %, P = 0.025) or the NPC group (63.6 vs. 78.0 %, P = 0.030). However, the 2-year OS rate among the three groups was comparable (72.7 vs. 79.9 %; P = 0.101) and 83.1 %, (P = 0.125). According to univariable analysis, tumor size (>5 cm), tumor number (≥2), tumor grade (low/undifferentiated), TNM stage (III), vascular infiltration, blood transfusion, and IPC were significantly associated with the early postoperative recurrence of HCC. After multivariate analysis, significance of tumor grade (low/undifferentiated) and TNM stage (III) disappeared, whereas tumor size (>5 cm), tumor number (≥2), vascular infiltration, blood transfusion, and IPC remained significant.
IPC is an independent risk factor for the early recurrence of HCC after surgery.
评估手术期间间歇性门静脉阻断（IPC）对肝细胞癌（HCC）早期复发的影响。
本回顾性研究的对象为266例行肝癌根治性肝切除术的患者。患者分为以下几组：间歇性门静脉阻断（IPC）组，n = 78；持续性门静脉阻断（CPC）组，n = 128；非门静脉阻断（NPC）组，n = 60。
IPC组随访2年内的无复发生存期（14.2±4.6个月）显著短于CPC组（18.0±4.8个月，P = 0.008）或NPC组（19.04±4.1个月，P = 0.023）。此外，IPC组的2年无复发生存率远低于CPC组（63.6%对75.8%，P = 0.025）或NPC组（63.6%对78.0%，P = 0.030）。然而，三组的2年总生存率相当（72.7%对79.9%；P = 0.101）和83.1%，（P = 0.125）。单因素分析显示，肿瘤大小（>5 cm）、肿瘤数量（≥2个）、肿瘤分级（低/未分化）、TNM分期（III期）、血管侵犯、输血和IPC与HCC术后早期复发显著相关。多因素分析后，肿瘤分级（低/未分化）和TNM分期（III期）的显著性消失，而肿瘤大小（>5 cm）、肿瘤数量（≥2个）、血管侵犯、输血和IPC仍具有显著性。
IPC是HCC术后早期复发的独立危险因素。
