Famularo Simone, Donadon Matteo, Cipriani Federica, Ardito Francesco, Carissimi Francesca, Perri Pasquale, Iaria Maurizio, Dominioni Tommaso, Zanello Matteo, Conci Simone, Molfino Sarah, LaBarba Giuliano, Ferrari Cecilia, Germani Paola, Patauner Stefan, Pinotti Enrico, Lodo Enrico, Garatti Marco, Sciannamea Ivano, Troci Albert, Conticchio Maria, Floridi Antonio, Chiarelli Marco, Fumagalli Luca, Memeo Riccardo, Crespi Michele, Antonucci Adelmo, Zimmitti Giuseppe, Zanus Giacomo, Zago Mauro, Frena Antonio, Tarchi Paola, Griseri Guido, Ercolani Giorgio, Baiocchi Gian Luca, Ruzzenente Andrea, Jovine Elio, Maestri Marcello, DallaValle Raffaele, Grazi Gian Luca, Giuliante Felice, Aldrighetti Luca, Torzilli Guido, Romano Fabrizio
School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
Updates Surg. 2020 Jun;72(2):399-411. doi: 10.1007/s13304-020-00733-6. Epub 2020 Mar 13.
Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63-75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5 years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power.
肝脏手术是肝癌的一线治疗方法。肝癌肝脏复发研究（HERCOLES）小组于2018年成立，旨在创建一个意大利中心网络，共享数据并促进外科领域肝细胞癌（HCC）的科学研究。这是第一份分析手术和肿瘤学结局趋势的全国性报告。登记数据由22个意大利中心在2008年至2018年期间收集。收集了164个变量，涉及肝功能状态、肿瘤负荷、放射学、术中及围手术期数据、组织学特征和肿瘤学随访情况。共纳入2381例患者。中位年龄为70岁（四分位间距63 - 75岁）。1491例患者（62.6%）存在肝硬化，其中Child - A级病例占89.9%。几乎50%的病例HCC被分期为BCLC0 - A期，而BCLC B期和C期分别为20.7%和17.9%。大肝切除术481例（20.2%），753例（31.6%）采用了腹腔镜手术。严重并发症仅发生在5%的患者中。10.5%的患者记录有术后腹水，4.9%观察到肝切除术后肝衰竭。90天死亡率为2.5%。5年时，总生存率为66.1%，无病生存率为40.9%。74.6%的病例复发位于肝内。高达32%的病例针对复发进行了再次手术和热消融。这是意大利关于HCC外科治疗全国经验的最新报告。该数据集持续支持参与中心开展多中心分析，这些分析已经在使用非常大的样本量且具有很强的效力。
