Shirata Chikara, Hasegawa Kiyoshi, Kokudo Takashi, Yamashita Suguru, Yamamoto Satoshi, Arita Junichi, Akamatsu Nobuhisa, Kaneko Junichi, Sakamoto Yoshihiro, Kokudo Norihiro
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
World J Surg. 2018 Dec;42(12):4054-4062. doi: 10.1007/s00268-018-4698-3.
The aim of this study was to evaluate the feasibility of liver resection in hepatocellular carcinoma (HCC) patients with preoperative renal dysfunction (RD).
Data from 735 patients undergoing primary liver resection for HCC between 2002 and 2014 were analyzed. Short- and long-term outcomes were compared between the RD group, defined by a preoperative estimated glomerular filtration rate of <45 mL/min/1.73 m, and the non-RD group.
Sixty-two patients had RD. The incidence of postoperative pleural effusion (24 vs. 11%; P = 0.007) and major complications (Clavien-Dindo III-V; 31 vs. 15%; P = 0.003) were significantly higher in RD patients. In RD patients with Child-Pugh A, 90-day mortality rate (1.9%) and median survival time (6.11 years) were comparable to that of non-RD patients. In contrast, RD patients with Child-Pugh B had a very high 90-day mortality rate (22.2%), and a significant shorter median survival time compared to non-RD patients (1.19 vs. 4.84 years; P = 0.001).
Liver resection for Child-Pugh A patients with RD is safe and has comparable oncological outcomes compared to non-RD patients. However, selection of liver resection candidates from Child-Pugh B patients with RD should be stricter.
本研究的目的是评估术前存在肾功能不全（RD）的肝细胞癌（HCC）患者行肝切除手术的可行性。
分析了2002年至2014年间735例行原发性肝癌肝切除手术患者的数据。将术前估计肾小球滤过率<45 mL/min/1.73 m定义为RD组，与非RD组比较短期和长期预后。
62例患者存在RD。RD患者术后胸腔积液发生率（24% 对11%；P = 0.007）和主要并发症（Clavien-Dindo III-V级；31% 对15%；P = 0.003）显著更高。Child-Pugh A级的RD患者，90天死亡率（1.9%）和中位生存时间（6.11年）与非RD患者相当。相比之下，Child-Pugh B级的RD患者90天死亡率非常高（22.2%），与非RD患者相比中位生存时间显著缩短（1.19年对4.84年；P = 0.001）。
对于Child-Pugh A级的RD患者，肝切除手术是安全的，与非RD患者相比肿瘤学预后相当。然而，对于Child-Pugh B级的RD患者，肝切除手术候选者的选择应更严格。
