Wagle Prasad, Narkhede Rajvilas, Desai Gunjan, Pande Prasad, Kulkarni D R, Varty Paresh
Lilavati Hospital and Research Centre, A-791, Bandra Reclamation, Bandra (West), Mumbai-400050, India.
Balabhai Nanavati Superspeciality Hospital, Mumbai, Maharashtra- 400056, India.
Arq Bras Cir Dig. 2020 Jul 28;33(2):e1505. doi: 10.1590/0102-672020190001e1505. eCollection 2020.
Majority of patients with large size HCC (>10 cm) are not offered surgery as per Barcelona Clinic Liver Cancer (BCLC) criteria and hence, their outcomes are not well studied, especially from India, owing to a lower incidence.
To analyze outcomes of surgery for large HCCs.
This retrospective observational study included all patients who underwent surgery for large HCC from January 2007 to December 2017. The entire perioperative and follow up data was collected and analyzed.
Nineteen patients were included. Ten were non-cirrhotic; 16 were BCLC grade A; one BCLC grade B; and two were BCLC C. Two cirrhotic and three non-cirrhotic underwent preoperative sequential trans-arterial chemoembolization and portal vein embolization. Right hepatectomy was the most commonly done procedure. The postoperative 30-day mortality rate was 5% (1/19). Wound infection and postoperative ascites was seen in seven patients each. Postoperative liver failure was seen in five. Two cirrhotic and two non-cirrhotic patients had postoperative bile leak. The hospital stay was 11.9±5.4 days (median 12 days). Vascular invasion was present in four cirrhotic and five non-cirrhotic patients. The median follow-up was 32 months. Five patients died in the follow-up period. Seven had recurrence and median recurrence free survival was 18 months. The cumulative recurrence free survival was 88% and 54%, whereas the cumulative overall survival was 94% and 73% at one and three years respectively. Both were better in non-cirrhotic; however, the difference was not statistically significant. The recurrence free survival was better in patients without vascular invasion and the difference was statistically significant (p=0.011).
Large HCC is not a contraindication for surgery. Vascular invasion if present, adversely affects survival. Proper case selection can provide the most favorable survival with minimal morbidity.
根据巴塞罗那临床肝癌（BCLC）标准，大多数大尺寸肝癌（>10 cm）患者未接受手术治疗，因此，由于发病率较低，其治疗结果尚未得到充分研究，尤其是来自印度的相关研究较少。
分析大肝癌手术的治疗结果。
这项回顾性观察性研究纳入了2007年1月至2017年12月期间接受大肝癌手术的所有患者。收集并分析了整个围手术期和随访数据。
共纳入19例患者。其中10例为非肝硬化患者；16例为BCLC A期；1例为BCLC B期；2例为BCLC C期。2例肝硬化患者和3例非肝硬化患者接受了术前序贯经动脉化疗栓塞和门静脉栓塞。右半肝切除术是最常用的手术方式。术后30天死亡率为5%（1/19）。7例患者出现伤口感染，7例出现术后腹水。5例出现术后肝衰竭。2例肝硬化患者和2例非肝硬化患者出现术后胆漏。住院时间为11.9±5.4天（中位数12天）。4例肝硬化患者和5例非肝硬化患者存在血管侵犯。中位随访时间为32个月。随访期间5例患者死亡。7例复发，无复发生存期中位数为18个月。1年和3年的累积无复发生存率分别为88%和54%，而累积总生存率分别为94%和73%。非肝硬化患者的这两项指标均较好；然而，差异无统计学意义。无血管侵犯患者的无复发生存率较好，差异有统计学意义（p=0.011）。
大肝癌并非手术禁忌证。若存在血管侵犯，会对生存产生不利影响。合理的病例选择可使患者获得最有利的生存，且并发症最少。
