Yamaguchi Takamune, Kokudo Takashi, Akamatsu Nobuhisa, Kaneko Junichi, Arita Junichi, Sakamoto Yoshihiro, Kokudo Norihiro, Hasegawa Kiyoshi
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
National Center for Global Health and Medicine, Tokyo, Japan.
World J Surg. 2018 Dec;42(12):4070-4080. doi: 10.1007/s00268-018-4714-7.
Repeated resection is known to prolong survival, with an acceptable morbidity rate, in patients with hepatocellular carcinoma. However, little is known about the effect of repeated liver resection on postoperative liver regeneration and liver function. The aim of this study is to determine the impact of repeated liver resections on the postoperative liver regeneration rate and liver function.
A total of 71 patients, who had undergone more than three liver resections for hepatocellular carcinoma between May 2001 and December 2013 at a tertiary care hospital in Japan, were included in the analysis. Among them, CT-volumetric data for the first, second, third, and fourth or more resections were available for 36, 49, 53, and 24 patients. We analyzed the regeneration index (RI) defined as the postoperative TLV/preoperative TLV × 100 was calculated after each operation to measure the degree of regeneration. Liver function was evaluated using the indocyanine green retention rate at 15 min (ICG-R15).
No significant differences in RI were observed among the first, second, and third or more liver resection groups. No significant difference in the ICG R15 value was seen between the first liver resection group and the second or more liver resection group (P = 0.75). However, a significant difference in the RI was observed when the 1 segmentectomy or less liver resection group (median [range] RI 98.1 [72.9-119.9]) was compared with the 2 or more segmentectomy group (median [range] RI 90.5 [62.6-113.6]) (P = 0.005).
The regeneration process is maintained after as many as four repeated resections. Patients with sustained liver function can safely undergo repeated liver resections for recurrences of HCC.
已知在肝细胞癌患者中，重复肝切除术可延长生存期，且发病率可接受。然而，关于重复肝切除术对术后肝再生和肝功能的影响知之甚少。本研究的目的是确定重复肝切除术对术后肝再生率和肝功能的影响。
对2001年5月至2013年12月期间在日本一家三级医疗中心因肝细胞癌接受三次以上肝切除术的71例患者进行分析。其中，分别有36例、49例、53例和24例患者可获得首次、第二次、第三次以及第四次或更多次肝切除术的CT容积数据。我们分析了再生指数（RI），其定义为每次手术后计算术后总肝体积（TLV）/术前TLV×100，以测量再生程度。使用15分钟时的吲哚菁绿滞留率（ICG-R15）评估肝功能。
首次、第二次以及第三次或更多次肝切除组之间的RI无显著差异。首次肝切除组与第二次或更多次肝切除组之间的ICG R15值无显著差异（P = 0.75）。然而，当将肝段切除1个及以下的肝切除组（RI中位数[范围]98.1[72.9 - 119.9]）与肝段切除2个及以上的肝切除组（RI中位数[范围]90.5[62.6 - 113.6]）进行比较时，RI存在显著差异（P = 0.005）。
多达四次重复肝切除术后肝再生过程得以维持。肝功能持续良好的患者可安全地接受重复肝切除术以治疗肝癌复发。
