Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Berlin Institute of Health (BIH), Berlin, Germany.
J Gastrointest Surg. 2018 May;22(5):840-848. doi: 10.1007/s11605-018-3690-4. Epub 2018 Jan 23.
BACKGROUND: Both liver transplantation (LT) and liver resection (LR) represent curative treatment options for hepatocellular carcinoma (HCC) in patients with liver cirrhosis. In this study, we have compared outcomes between historical and more recent patient cohorts scheduled either for LT or LR, respectively. METHODS: Clinicopathological data of all patients with HCC and cirrhosis who underwent LT or LR between 1989 and 2011 were evaluated. Overall survival of patients with HCC within the Milan criteria (MC) was analyzed focusing on changes between different time periods. RESULTS: In total, 364 and 141 patients underwent LT and LR for HCC in cirrhosis, respectively. Among patients with HCC within MC, 214 and 59 underwent LT and LR, respectively. Postoperative morbidity (37 vs. 11%, P < .0001), but not mortality (3 vs. 1%, P = .165), was higher after LR than after LT for HCC within MC. In the period 1989-2004, overall survival (OS) was significantly higher in patients who underwent LT compared to LR for HCC within MC (5-year OS: 77 vs. 36%, P < .0001). Interestingly, in the more recent period 2005-2011, OS was comparable between LT and LR for HCC within MC (5-year OS: 73 vs. 61%, P = .07). CONCLUSION: We have noted an improvement of outcomes among patients selected for partial hepatectomy in recent years that were comparable to stable results after LT in cirrhotic patients with HCC. Whether those improvements are due to advances in liver surgery, optimized perioperative managament for patients with liver cirrhosis, and the development of modern multimodal treatment strategies for the recurrent lesions appears plausible.
背景：肝移植（LT）和肝切除术（LR）都是肝硬化患者治疗肝细胞癌（HCC）的有效方法。本研究比较了分别接受 LT 或 LR 的历史和近期患者队列的结局。
方法：评估了 1989 年至 2011 年间接受 LT 或 LR 的所有 HCC 和肝硬化患者的临床病理数据。分析了米兰标准（MC）范围内 HCC 患者的总生存率，重点关注不同时期的变化。
结果：共有 364 例和 141 例 HCC 肝硬化患者分别接受 LT 和 LR。MC 范围内 HCC 患者中，214 例和 59 例分别接受 LT 和 LR。MC 范围内 HCC 患者接受 LR 后，术后发病率（37%比 11%，P<0.0001），但死亡率（3%比 1%，P=0.165）并不高于 LT。在 1989-2004 年期间，MC 范围内 HCC 患者接受 LT 的总生存率（OS）明显高于 LR（5 年 OS：77%比 36%，P<0.0001）。有趣的是，在 2005-2011 年期间，MC 范围内 HCC 患者接受 LT 和 LR 的 OS 相当（5 年 OS：73%比 61%，P=0.07）。
结论：近年来，我们注意到接受部分肝切除术治疗的患者的结果有所改善，与 MC 范围内 HCC 肝硬化患者接受 LT 的稳定结果相当。这些改善是否归因于肝外科技术的进步、肝硬化患者围手术期管理的优化以及现代多模式治疗策略的发展，这似乎是合理的。
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