Garancini Mattia, Pinotti Enrico, Nespoli Stefano, Romano Fabrizio, Gianotti Luca, Giardini Vittorio
Mattia Garancini, Enrico Pinotti, Stefano Nespoli, Fabrizio Romano, Luca Gianotti, Vittorio Giardini, Department of Surgery, Hepatobiliopancreatic Unit, San Gerardo Hospital, University of Milano Bicocca, 20900 Monza, Italy.
World J Hepatol. 2016 Apr 18;8(11):513-9. doi: 10.4254/wjh.v8.i11.513.
Hepatocellular carcinoma (HCC) is the main common primary tumour of the liver and it is usually associated with cirrhosis. The barcelona clinic liver cancer (BCLC) classification has been approved as guidance for HCC treatment algorithms by the European Association for the Study of Liver and the American Association for the Study of Liver Disease. According to this algorithm, hepatic resection should be performed only in patients with small single tumours of 2-3 cm without signs of portal hypertension (PHT) or hyperbilirubinemia. BCLC classification has been criticised and many studies have shown that multiple tumors and large tumors, as wide as those with macrovascular infiltration and PHT, could benefit from liver resection. Consequently, treatment guidelines should be revised and patients with intermediate/advanced stage HCC, when technically resectable, should receive the opportunity to be treated with radical surgical treatment. Nevertheless, the surgical treatment of HCC on cirrhosis is complex: The goal to be oncologically radical has always to be balanced with the necessity to minimize organ damage. The aim of this review was to analyze when and how liver resection could be indicated beyond BCLC indication. In particular, the role of multidisciplinary approach to assure a proper indication, of the intraoperative ultrasound for intra-operative restaging and resection guidance and of laparoscopy to minimize surgical trauma have been enhanced.
肝细胞癌（HCC）是肝脏最常见的主要原发性肿瘤，通常与肝硬化相关。巴塞罗那临床肝癌（BCLC）分期已被欧洲肝脏研究协会和美国肝病研究协会批准作为HCC治疗方案的指导。根据该方案，肝切除术仅适用于单发小肿瘤（2 - 3厘米）且无门静脉高压（PHT）或高胆红素血症迹象的患者。BCLC分期受到了批评，许多研究表明，多发肿瘤、大肿瘤，以及伴有大血管浸润和PHT的肿瘤，也可能从肝切除术中获益。因此，治疗指南应予以修订，对于中期/晚期HCC患者，在技术上可切除时，应给予其接受根治性手术治疗的机会。然而，肝硬化患者的HCC手术治疗很复杂：肿瘤根治的目标始终要与尽量减少器官损伤的必要性相平衡。本综述的目的是分析在BCLC分期标准之外，何时以及如何进行肝切除术。特别是，多学科方法在确保合适手术指征方面的作用、术中超声在术中再分期和切除指导方面的作用，以及腹腔镜检查在减少手术创伤方面的作用都得到了强化。
