Li Yao, Li Peng-Peng, Sun Da-Peng, Ni Jun-Sheng, Liu Hui, Pan Ze-Ya, Yang Yuan, Zhao Ling-Hao, Lau Wan Yee, Huang Gang, Zhou Wei-Ping
The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
Hepatobiliary Surg Nutr. 2022 Oct;11(5):662-674. doi: 10.21037/hbsn-20-711.
For patients with a large but resectable solitary hepatocellular carcinoma (HCC) of >5 cm in diameter, it is often difficult to achieve a sufficient resection margin. There is still no study on whether a two-stage hepatectomy to increase a narrow resection margin would be beneficial.
From August 2014 to February 2017, patients with a large but resectable solitary HCC of >5 cm and a preoperative estimated resection margin of <1.0 cm were retrospectively studied. They were divided into one- and two-stage resection groups. A retrospective analysis was performed, followed by propensity score matching (PSM) analysis. Disease recurrence, survival, intraoperative and postoperative data were compared.
Before PSM, the 1-, 2-, 3-and 4-year recurrence-free survival rates for the one- and two-stage groups were 44.3%, 31.7%, 24.3%, 19.2% versus 60.6%, 45.4%, 43.5%, 32.3%, respectively (P=0.007). The corresponding OS rates were 61.0%, 45.2%, 43.8%, 38.4% versus 69.6%, 62.5%, 60.7%, 57.3%, respectively (P=0.029). After PSM, the 1-, 2-, 3-and 4-year recurrence-free survival rates for the one- and two-stage groups were 44.0%, 31.5%, 27.3%, 21.0% versus 60.6%, 45.4%, 43.5%, 32.3%, respectively (P=0.013). The corresponding OS rates were 62.5%, 41.1%, 41.1%, 37.5% versus 69.6%, 62.5%, 60.7%, 57.3%, respectively (P=0.038). Differences in the resection margins between the one- and two-stage groups before [0.3 (0-0.5) versus 1.2 (0.8-2.2) cm] and after [0.2 (0-0.5) versus 1.2 (0.8-2.2) cm] PSM were also significant.
Two-stage hepatectomy allowed a wider resection margin for patients with a resectable but solitary HCC of >5 cm, and resulted in significantly better long-term survival outcomes after partial hepatectomy.
对于直径大于5cm的可切除的巨大孤立性肝细胞癌（HCC）患者，往往难以获得足够的切缘。目前尚无关于两阶段肝切除术能否增加狭窄切缘是否有益的研究。
回顾性研究2014年8月至2017年2月期间，直径大于5cm、术前估计切缘小于1.0cm的可切除的巨大孤立性HCC患者。将他们分为一期和两期切除组。进行回顾性分析，随后进行倾向评分匹配（PSM）分析。比较疾病复发、生存率、术中及术后数据。
在PSM之前，一期和两期组的1年、2年、3年和4年无复发生存率分别为44.3%、31.7%、24.3%、19.2%和60.6%、45.4%、43.5%、32.3%（P=0.007）。相应的总生存率分别为61.0%、45.2%、43.8%、38.4%和69.6%、62.5%、60.7%、57.3%（P=0.029）。PSM之后，一期和两期组的1年、2年、3年和4年无复发生存率分别为44.0%、31.5%、27.3%、21.0%和60.6%、45.4%、43.5%、32.3%（P=0.013）。相应的总生存率分别为62.5%、41.1%、41.1%、37.5%和69.6%、62.5%、60.7%、57.3%（P=0.038）。PSM之前[0.3（0-0.5）对1.2（0.8-2.2）cm]和之后[0.2（0-0.5）对1.2（0.8-2.2）cm]一期和二期组之间的切缘差异也很显著。
两阶段肝切除术可为直径大于5cm的可切除但孤立性HCC患者提供更宽的切缘，并在肝部分切除术后带来显著更好的长期生存结果。
