Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochi, 321-0293, Japan.
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
World J Surg. 2021 Feb;45(2):607-614. doi: 10.1007/s00268-020-05830-6. Epub 2020 Oct 26.
Non-curative (debulking) hepatic resection for hepatocellular carcinoma (HCC) is occasionally applied for selected cases with bulky tumors or for oncologic emergency cases; however, the clinical usefulness of this procedure has not yet been fully evaluated. The aim of the present study was to evaluate the patient outcomes of non-curative hepatic resections for HCC using data from bi-annual nationwide surveys conducted in Japan.
Data of 1084 non-curative hepatic resections for HCC were collected. The patient outcomes were compared with those of curative resections, transcatheter arterial chemoembolization (TACE), and hepatic arterial infusion chemotherapy (HAIC).
Patient survival after the non-curative resection was poorer than that after curative resection (P < 0.001) and was especially dismal in cases with extrahepatic tumor spread (lymph node metastasis, peritoneal seeding, or distant metastasis). As compared to cases receiving TACE without surgery, non-curative resections for multiple intrahepatic tumors were applied to cases with advanced tumors with good liver functional reserve. The survival outcomes were significantly more favorable in the TACE group, but the results became similar after propensity score matching of the patients. The survival outcome of patients receiving non-curative resections was better than that of cases treated by HAIC, with median survival times of 26.0 months and 10.0 months, respectively.
The indications for non-curative hepatic resection in patients with HCC should be judged cautiously, especially in patients with extrahepatic tumor spread. This treatment approach may be beneficial for selected patients with intermediate- or advanced-stage HCC limited in liver and with good liver functional reserve.
非治愈性（去块）肝切除术偶尔适用于体积较大的肿瘤或肿瘤急症的选定病例；然而，该手术的临床应用价值尚未得到充分评估。本研究旨在利用日本两年一次的全国性调查数据，评估非治愈性肝切除术治疗肝细胞癌（HCC）的患者结局。
收集了 1084 例非治愈性 HCC 肝切除术的数据。将患者的结局与治愈性切除术、经导管动脉化疗栓塞术（TACE）和肝动脉灌注化疗（HAIC）的结果进行比较。
非治愈性肝切除术后患者的生存状况比治愈性切除术后差（P<0.001），且在合并肝外肿瘤转移（淋巴结转移、腹膜播种或远处转移）的病例中更为恶劣。与未接受手术的 TACE 病例相比，多发肝内肿瘤的非治愈性切除术适用于具有良好肝功能储备的晚期肿瘤患者。TACE 组的生存结果明显更优，但在对患者进行倾向评分匹配后，结果变得相似。接受非治愈性肝切除术的患者的生存结果优于接受 HAIC 治疗的患者，中位生存时间分别为 26.0 个月和 10.0 个月。
应谨慎判断 HCC 患者行非治愈性肝切除术的适应证，尤其是对于合并肝外肿瘤转移的患者。对于局限于肝脏且具有良好肝功能储备的中晚期 HCC 患者，该治疗方法可能有益。
