Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Int J Surg. 2018 Apr;52:297-302. doi: 10.1016/j.ijsu.2018.02.059. Epub 2018 Mar 9.
Both central hepatectomy (CH) and major hepatectomy (MH) are suggested surgical treatments for patients with centrally located hepatocellular carcinoma (CL-HCC). However, no consensus has been reached regarding which method is superior for managing these patients. This meta-analysis was conducted to compare the short- and long-term outcomes of CH and MH in patients with CL-HCC.
An electronic search for studies published in all years up to July 2017 in PubMed (Medline), EMBASE, Cochrane Library and Web of Science was performed. The short-term outcome was the incidence of postoperative complications, and the long-term outcomes included 1-, 3- and 5-year overall survival (OS) and corresponding disease-free survival (DFS), mortality and morbidity. The results were presented as Risk Ratios (RRs) or weighted mean differences with 95% confidence intervals.
Four retrospective studies containing 465 patients with CL-HCC were included (248 in the CH group and 217 in the MH group). The results suggested no significant differences in the 1-, 3- and 5-year DFS, 1, 3 and 5-year OS, total morbidity or mortality between these groups. Nevertheless, the patients in the CH group presented a lower prevalence of vascular invasion (RR 0.70, 95% CI 0.52-0.93, P = 0.020) than did the MH group. In addition, CH led to a higher incidence of biliary fistula, while MH showed a higher incidence of postoperative liver failure.
This study demonstrated that the long-term outcomes of the patients with CL-HCC in these two groups were not significantly different. For short-term outcomes, CH resulted in a lower rate of postoperative liver failure, while MH resulted in a lower incidence of biliary fistula. Nonetheless, compared with MH, CH provided CL-HCC patients with greater future remnant liver volume without an increased risk of early intra-hepatic recurrence. More multi-centre, randomized controlled trials comparing the therapeutic efficacy of CH and MH are urgently warranted.
对于中央型肝癌（CL-HCC）患者，建议采用中央肝切除术（CH）和大肝切除术（MH）作为治疗方法。然而，目前对于哪种方法更适合管理这些患者尚无共识。本研究旨在比较 CH 和 MH 治疗 CL-HCC 患者的短期和长期疗效。
通过电子检索 PubMed（Medline）、EMBASE、Cochrane 图书馆和 Web of Science 中所有年份截至 2017 年 7 月发表的研究。短期结果为术后并发症发生率，长期结果包括 1、3 和 5 年总生存率（OS）和无病生存率（DFS）、死亡率和发病率。结果以风险比（RR）或加权均数差及其 95%置信区间表示。
共纳入 4 项回顾性研究，共纳入 465 例 CL-HCC 患者（CH 组 248 例，MH 组 217 例）。结果表明两组患者的 1、3、5 年 DFS、1、3、5 年 OS、总发病率或死亡率无显著差异。然而，CH 组患者血管侵犯的发生率低于 MH 组（RR 0.70，95%CI 0.52-0.93，P=0.020）。此外，CH 组胆瘘发生率较高，而 MH 组术后肝功能衰竭发生率较高。
本研究表明，两组 CL-HCC 患者的长期疗效无显著差异。对于短期结果，CH 术后肝功能衰竭发生率较低，而 MH 术后胆瘘发生率较低。然而，与 MH 相比，CH 为 CL-HCC 患者提供了更大的未来剩余肝体积，而不会增加早期肝内复发的风险。目前迫切需要开展更多的多中心、随机对照试验，比较 CH 和 MH 的治疗效果。
