Hepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Japan.
Okinaka Memorial Institute for Medical Disease, Tokyo, Japan.
HPB (Oxford). 2019 Aug;21(8):990-997. doi: 10.1016/j.hpb.2018.12.001. Epub 2019 Jan 31.
Recent advances in liver surgery have dramatically improved the safety of hepatectomy for hepatocellular carcinoma (HCC). The aim of this study was to compare outcomes for patients fulfilling an extended criteria vs. those fulfilling the conventional criteria based on the bilirubin and indocyanine green (ICG) clearance (Makuuchi's criteria).
The short term outcomes of patients undergoing hepatectomy for HCC and who fulfilled the expanded criteria (ICG clearance of future remnant liver [ICG-Krem] ≥ 0.05 estimated using 3-D volumetry) were retrospectively reviewed and were compared between those fulfilling the conventional criteria. Postoperative hepatic insufficiency (PHI) was defined as peak total bilirubin >7 mg/dL.
A total of 323 patients undergoing resection of whom 269 (83%) met conventional criteria (In-M) and 54 (17%) extended criteria (Ex-M). The overall morbidity rates were not significantly different. The incidence of PHI was 0.37% in In-M and 3.7% in Ex-M (P = 0.074), with no liver-related deaths. When the ICG-Krem ≥ 0.05 criterion was included, major hepatectomy was performed in 24 patients (41%) in Ex-M with no significant increase in major morbidity (13%), PHI(3.3%), or liver-related death (0%) compared with minor hepatectomy (n = 30) in Ex-M(10%, 4% and 0%, respectively).
Objective criteria using ICG clearance rate and 3-D volumetry may offer opportunities for safe surgical resection in selected patients exceeding the conventional criteria.
近年来，肝外科的进步显著提高了肝细胞癌（HCC）肝切除术的安全性。本研究旨在比较满足胆红素和吲哚菁绿（ICG）清除率（Makuuchi 标准）扩展标准与常规标准的患者的结果。
回顾性分析满足扩展标准（使用 3D 体积法估计未来残留肝脏的 ICG 清除率 [ICG-Krem]≥0.05）行肝切除术的 HCC 患者的短期结果，并将其与满足常规标准的患者进行比较。术后肝功能不全（PHI）定义为总胆红素峰值>7mg/dL。
共 323 例患者行切除术，其中 269 例（83%）符合常规标准（In-M），54 例（17%）符合扩展标准（Ex-M）。总体发病率无显著差异。In-M 的 PHI 发生率为 0.37%，Ex-M 为 3.7%（P=0.074），无肝相关死亡。当 ICG-Krem≥0.05 标准纳入时，Ex-M 中有 24 例（41%）行主要肝切除术，主要发病率（13%）、PHI（3.3%）或肝相关死亡率（0%）无显著增加与 Ex-M 中的小肝切除术（分别为 10%、4%和 0%）相比。
使用 ICG 清除率和 3D 体积法的客观标准可能为超出常规标准的选定患者提供安全手术切除的机会。
