Field Wesley B S, Rostas Jack W, Philps Prejesh, Scoggins Charles R, McMasters Kelly M, Martin Robert C G
Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY, USA.
Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY, USA.
Am J Surg. 2017 Aug;214(2):273-277. doi: 10.1016/j.amjsurg.2017.06.002. Epub 2017 Jun 8.
The goal of this study was to compare the outcome after partial hepatectomy for hepatocellular carcinoma (HCC) in which a margin less than or equal to 5 mm or greater than 5 mm was achieved.
A review of our 3300-patient prospective HPB database was performed from 12/2002 to 4/2015. Patients were stratified into two groups: resection margins ≤5 ("narrow") and >5 mm ("wide") as measured on final pathologic assessment.
One-hundred thirty patients were included in the analysis (margin ≤5 mm, n = 41 and margin >5 mm, n = 89). At the time of analysis 54 patients had developed 56 recurrences, 15 (37%) in the narrow margin group and 41 (46%) in the wide margin group, p = 0.45. The pattern of recurrence was similar in the two groups: intrahepatic 11 (79%) versus 30 (75%), p = 1, and extra-hepatic 6 (43%) versus 17 (43%), p = 1. Median disease-free survival was similar in both groups, 18.1 versus 19.5 months (p = 0.85).
A narrow resection margin (5 mm or less) does not detract from oncologic outcomes after partial hepatectomy for HCC. Tailoring resection margins may lead to greater preservation of hepatic parenchyma. Factors other than margin status represent the driving forces for local and systemic recurrence.
本研究的目的是比较肝细胞癌（HCC）肝部分切除术后切缘小于或等于5毫米与大于5毫米的预后情况。
对我们2002年12月至2015年4月的3300例患者的前瞻性肝胆胰（HPB）数据库进行回顾。根据最终病理评估，将患者分为两组：切缘≤5毫米（“窄”）组和>5毫米（“宽”）组。
130例患者纳入分析（切缘≤5毫米组，n = 41；切缘>5毫米组，n = 89）。分析时，54例患者出现了56次复发，窄切缘组15例（37%），宽切缘组41例（46%），p = 0.45。两组复发模式相似：肝内复发分别为11例（79%）和30例（75%），p = 1；肝外复发分别为6例（43%）和17例（43%），p = 1。两组的无病生存期中位数相似，分别为18.1个月和19.5个月（p = 0.85）。
对于HCC肝部分切除术，窄切缘（5毫米或更小）并不影响肿瘤学预后。调整切缘可能会更多地保留肝实质。切缘状态以外的因素是局部和全身复发的驱动因素。
