Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
National Centre for Global Health and Medicine, Tokyo, Japan.
Br J Surg. 2019 Jul;106(8):1066-1074. doi: 10.1002/bjs.11153. Epub 2019 Apr 16.
Indications for hepatectomy in patients with hepatocellular carcinoma (HCC) who have portal hypertension (PH) have been controversial. Some studies have concluded that PH is a contraindication to hepatectomy, whereas others have suggested that perioperative prophylactic management (PPM) can help overcome complications after hepatectomy associated with PH. The objective of this retrospective study was to assess the short- and long-term outcomes after hepatectomy for HCC in patients with PH, with or without PPM.
Records were reviewed of consecutive patients who underwent hepatectomy for HCC, with or without PPM of PH, in a single institution from 1994 to 2015. Patients were divided into three groups: those who received PPM for PH (PPM group), patients who had PH but did not receive PPM (no-PPM group) and those without PH (no-PH group).
A total of 1259 patients were enrolled, including 123 in the PPM group, 181 in the no-PPM group and 955 in the no-PH group. Three- and 5-year overall survival rates were 74·3 and 53·1 per cent respectively in the PPM group, 69·2 and 54·9 per cent in the no-PPM group, and 78·1 and 64·2 per cent in the no-PH group (P = 0·520 for PPM versus no PPM, P = 0·027 for PPM versus no PH, and P < 0·001 for no PPM versus no PH). Postoperative morbidity and mortality rates were 26·0 and 0·8 per cent respectively in the PPM group, 29·8 and 1·1 per cent in the no-PPM group, and 20·3 and 0 per cent in the no-PH group.
The present study has demonstrated acceptable outcomes among patients with HCC who received appropriate management for PH in an Asian population. Enhancement of the safety of hepatic resection through use of PPM may provide a rationale for expansion of indications for hepatectomy in patients with PH.
对于合并门静脉高压症（PH）的肝细胞癌（HCC）患者，行肝切除术的适应证一直存在争议。一些研究得出的结论是 PH 是肝切除术的禁忌证，而另一些研究则认为围手术期预防性治疗（PPM）可以帮助克服与 PH 相关的肝切除术后并发症。本回顾性研究的目的是评估有或无 PPM 的 PH 合并 HCC 患者行肝切除术后的短期和长期结局。
回顾性分析了 1994 年至 2015 年期间在一家医疗机构接受 HCC 肝切除术治疗的连续患者的记录，其中包括接受 PH PPM 的患者（PPM 组）、有 PH 但未接受 PPM 的患者（无 PPM 组）和无 PH 的患者（无 PH 组）。
共纳入 1259 例患者，其中 PPM 组 123 例，无 PPM 组 181 例，无 PH 组 955 例。PPM 组患者的 3 年和 5 年总生存率分别为 74.3%和 53.1%，无 PPM 组分别为 69.2%和 54.9%，无 PH 组分别为 78.1%和 64.2%（PPM 组与无 PPM 组比较，P=0.520；PPM 组与无 PH 组比较，P=0.027；无 PPM 组与无 PH 组比较，P<0.001）。PPM 组患者的术后发病率和死亡率分别为 26.0%和 0.8%，无 PPM 组分别为 29.8%和 1.1%，无 PH 组分别为 20.3%和 0%。
本研究在亚洲人群中证实，对于接受适当 PH 管理的 HCC 患者，肝切除术具有可接受的结局。通过使用 PPM 提高肝切除术的安全性，可能为扩大 PH 患者肝切除术的适应证提供依据。
