Shen Yangyang, Li Pang, Cui Kai, Wang Zhendan, Yu Fachang, Tian He, Li Sheng
Shandong Cancer Hospital affiliated to Shandong University,Shandong Academy of Medical Sciences.
Department of General Surgery,Lianyuan People's Hospital of Hunan Province.
Int J Technol Assess Health Care. 2016 Jan;32(4):212-217. doi: 10.1017/S0266462316000374. Epub 2016 Oct 21.
Curative hepatectomy and tumor thrombectomy for hepatocellular carcinoma with complicating biliary tumor thrombosis (HCC/BTT) is associated with high surgical morbidity and mortality. This retrospective study evaluated the effectiveness and safety of neoadjuvant transcatheter arterial chemoembolization (TACE) in HCC/BTT patients scheduled for curative resection.
Thirty consecutive patients with diagnosed HCC/BTT were hospitalized for neoadjuvant TACE and elective curative liver resection (group A; n=20) or curative liver resection alone (group B; n=10). The primary outcome measure was median survival.
Group A had a significantly shorter overall operative time (160±25 versus 190±35 min; p < .01) and duration of inflow control (14.3±3.6 versus 25.1±5.1 min; p < .01) and significantly less intraoperative blood loss (150±35 versus 520±75 ml; p < .01) and transfusion (100±40 versus 375±55 ml; p < .01) as compared to group B. Among patients undergoing both thrombectomy and curative resection, the median survival of group A was significantly longer than that of group B (28.5 [9-54] versus 21.5 [6-39] months; p < .01); among those who received thrombectomy alone, the median survival of group A was also significantly longer than that of group B (12.8 [6-25] versus 4.5 [2-7] months; p < .01).
Neoadjuvant TACE significantly reduced the surgical risk of curative liver resection and significantly prolonged median survival in HCC patients with complicating BTT.
对合并胆管肿瘤血栓形成的肝细胞癌（HCC/BTT）进行根治性肝切除术和肿瘤血栓切除术，手术并发症发生率和死亡率较高。本回顾性研究评估了新辅助经动脉化疗栓塞术（TACE）在计划进行根治性切除的HCC/BTT患者中的有效性和安全性。
连续30例诊断为HCC/BTT的患者因新辅助TACE和择期根治性肝切除术入院（A组；n = 20）或仅行根治性肝切除术（B组；n = 10）。主要观察指标为中位生存期。
与B组相比，A组的总手术时间显著缩短（160±25对190±35分钟；p <.01）和入流控制时间显著缩短（14.3±3.6对25.1±5.1分钟；p <.01），术中失血量显著减少（150±35对520±75毫升；p <.01）和输血量显著减少（100±40对375±55毫升；p <.01）。在同时进行血栓切除术和根治性切除术的患者中，A组的中位生存期显著长于B组（28.5 [9 - 54]对21.5 [6 - 39]个月；p <.01）；在仅接受血栓切除术的患者中，A组的中位生存期也显著长于B组（12.8 [6 - 25]对4.5 [2 - 7]个月；p <.01）。
新辅助TACE显著降低了根治性肝切除术的手术风险，并显著延长了合并BTT的HCC患者的中位生存期。
