Chen Zheng-Liang, Yao Lan-Qing, Pu Jia-Le, Wu Han, Xu Xin-Fei, Chen Ting-Hao, Zhou Ya-Hao, Wang Hong, Chen Zhi-Yu, Sun Li-Yang, Diao Yong-Kang, Zhong Jian-Hong, Lau Wan Yee, Pawlik Timothy M, Huang Dong-Sheng, Shen Feng, Liang Ying-Jian, Yang Tian
Department of Hepatobiliary Surgery, The 1st Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Military University, Second Military Medical University, Shanghai, China.
Eur J Surg Oncol. 2022 May;48(5):1078-1086. doi: 10.1016/j.ejso.2021.11.118. Epub 2021 Nov 20.
Portal hypertension due to cirrhosis is common among patients with hepatocellular carcinoma (HCC). This study aimed to compare the outcomes of partial hepatectomy in patients with HCC and clinically significant portal hypertension (CSPH) with or without concurrent splenectomy and esophagogastric devascularization (CSED).
From a multicenter database, patients with HCC and CSPH who underwent curative-intent hepatectomy were identified. Postoperative morbidity and mortality, and long-term overall survival (OS) were compared in patients with and without CSED before and after propensity score matching (PSM).
Of the 358 enrolled patients, 86 patients underwent CSED. Before PSM, the postoperative 30-day morbidity and mortality rates were comparable between the CSED and non-CSED group (both P > 0.05). Using PSM, 81 pairs of patients were created. In the PSM cohort, the 5-year OS rate of the CSED group were significantly better than the non-CSED group (52.9% vs. 36.5%, P= 0.046). The former group had a significantly lower rate of variceal bleeding on follow-up (7.4% vs. 21.7%, P= 0.014). On multivariate analysis, CSED was associated with significantly better OS (HR: 0.39, P < 0.001).
Hepatectomy and CSED can safely be performed in selected patients with HCC and CSPH, which could improve postoperative prognosis by preventing variceal bleeding, and prolonging long-term survival.
肝硬化所致门静脉高压在肝细胞癌（HCC）患者中很常见。本研究旨在比较肝细胞癌合并具有临床意义的门静脉高压（CSPH）患者行肝部分切除术时，同期行脾切除及食管胃去血管化术（CSED）与不行该手术的疗效。
从多中心数据库中识别出接受根治性肝切除术的肝细胞癌合并CSPH患者。在倾向评分匹配（PSM）前后，比较行CSED与未行CSED患者的术后发病率、死亡率及长期总生存率（OS）。
358例入组患者中，86例行CSED。PSM前，CSED组与未行CSED组术后30天发病率和死亡率相当（均P>0.05）。采用PSM创建了81对患者。在PSM队列中，CSED组5年总生存率显著高于未行CSED组（52.9%对36.5%，P=0.046）。前一组随访时静脉曲张出血率显著更低（7.4%对21.7%，P=0.014）。多因素分析显示，CSED与显著更好的总生存率相关（HR：0.39，P<0.001）。
对于部分选定的肝细胞癌合并CSPH患者，肝切除术联合CSED可安全实施，该术式可通过预防静脉曲张出血及延长长期生存来改善术后预后。
