Panwar Rajesh, Pal Sujoy, Dash Nihar R, Sahni Peush, Acharya Subrat K, Pande Girisk K, Chattopadhyay Tushar K, Nundy Samiran
Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, 110 029, India.
Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India.
Indian J Gastroenterol. 2016 Jul;35(4):280-6. doi: 10.1007/s12664-016-0678-4. Epub 2016 Aug 12.
There are no large series on hepatic resection for hepatocellular carcinoma (HCC) from India. We present the results of consecutive patients of HCC treated with hepatic resection at a tertiary care center in India.
The records of all patients who underwent hepatic resection for HCC in the Department of Gastrointestinal Surgery, All India Institute of Medical Sciences (New Delhi), were reviewed. The relevant perioperative and follow up data were extracted from a prospectively maintained database.
Between January 1987 and December 2013, 81 patients [71 males; mean age: 49.2 ± 15.6 years] underwent hepatic resection for HCC. Of these, 23 (28 %) were cirrhotic and 36 (49 %) had hepatitis B. Hepatitis B was significantly more common in cirrhotic (77 % vs. 37 %; p = 0.001). Most patients had locally advanced disease at presentation [tumor size ≥10 cm in 61 (75 %); vascular tumor thrombus in 10 (12 %)]. Anatomical resection was done in 61 (75 %) including 56 major hepatic resections (≥3 segments). Overall in-hospital mortality was 13 (16 %) [cirrhotic 5 (22 %) vs. noncirrhotic 8 (14 %), p = 0.503]. Grade III-V complications (modified Clavien-Dindo classification) occurred in 25 (31 %) patients (cirrhotic 48 % vs. noncirrhotic 24 %; p = 0.037). Follow up information was available for 51 (75 %) patients. The median time to recurrence was 12 months, and most (86 %) occurred within 1 year. The recurrence-free survival at 1, 3, and 5 years was 48 %, 40 %, and 36 %, respectively. Positive resection margin and vascular invasion were significantly associated with very poor prognosis.
Majority of Indian HCC patients present with locally advanced disease. Despite this, surgical resection provides a chance for long-term recurrence-free survival in a third of them.
印度尚无关于肝细胞癌（HCC）肝切除的大型系列研究。我们呈现了印度一家三级医疗中心连续接受肝切除治疗的HCC患者的结果。
回顾了全印度医学科学研究所（新德里）胃肠外科所有接受HCC肝切除患者的记录。相关围手术期和随访数据从前瞻性维护的数据库中提取。
1987年1月至2013年12月期间，81例患者[71例男性；平均年龄：49.2±15.6岁]接受了HCC肝切除。其中，23例（28%）为肝硬化患者，36例（49%）有乙型肝炎。乙型肝炎在肝硬化患者中明显更常见（77%对37%；p = 0.001）。大多数患者就诊时为局部晚期疾病[61例（75%）肿瘤大小≥10 cm；10例（12%）有血管内肿瘤血栓]。61例（75%）进行了解剖性切除，包括56例主要肝切除（≥3个肝段）。总体住院死亡率为13例（16%）[肝硬化患者5例（22%）对非肝硬化患者8例（14%），p = 0.503]。25例（31%）患者发生Ⅲ - V级并发症（改良Clavien - Dindo分类）（肝硬化患者48%对非肝硬化患者24%；p = 0.037）。51例（75%）患者有随访信息。复发的中位时间为12个月，大多数（86%）在1年内发生。1年、3年和5年的无复发生存率分别为48%、40%和36%。切缘阳性和血管侵犯与预后极差显著相关。
大多数印度HCC患者就诊时为局部晚期疾病。尽管如此，手术切除仍为其中三分之一的患者提供了长期无复发生存的机会。
