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肝细胞癌的科学肝切除术

Scientific Hepatectomy for Hepatocellular Carcinoma.

作者信息

Gu Jin, Liang Bin-Yong, Zhang Er-Lei, Zhang Zun-Yi, Chen Xiao-Ping, Huang Zhi-Yong

机构信息

Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.

Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China.

出版信息

Curr Med Sci. 2023 Oct;43(5):897-907. doi: 10.1007/s11596-023-2761-2. Epub 2023 Jun 22.

Abstract

With advances in imaging technology and surgical instruments, hepatectomy can be perfectly performed with technical precision for hepatocellular carcinoma (HCC). However, the 5-year tumor recurrence rates remain greater than 70%. Thus, the strategy for hepatectomy needs to be reappraised based on insights of scientific advances. Scientific evidence has suggested that the main causes of recurrence after hepatectomy for HCC are mainly related to underlying cirrhosis and the vascular spread of tumor cells that basically cannot be eradicated by hepatectomy. Liver transplantation and systemic therapy could be the solution to prevent postoperative recurrence in this regard. Therefore, determining the severity of liver cirrhosis for choosing the appropriate surgical modality, such as liver transplantation or hepatectomy, for HCC and integrating newly emerging immune-related adjuvant and/or neoadjuvant therapy into the strategy of hepatectomy for HCC have become new aspects of exploration to optimize the strategy of hepatectomy. In this new area, hepatectomy for HCC has evolved from a pure technical concept emphasizing anatomic resection into a scientific concept embracing technical considerations and scientific advances in underlying liver cirrhosis, vascular invasion, and systemic therapy. By introducing the concept of scientific hepatectomy, the indications, timing, and surgical techniques of hepatectomy will be further scientifically optimized for individual patients, and recurrence rates will be decreased and long-term survival will be further prolonged.

摘要

随着成像技术和手术器械的进步,肝细胞癌(HCC)的肝切除术可以在技术精度上完美实施。然而,5年肿瘤复发率仍高于70%。因此,需要基于科学进展的见解重新评估肝切除术的策略。科学证据表明,HCC肝切除术后复发的主要原因主要与潜在的肝硬化以及肿瘤细胞的血管播散有关,而肝切除术基本上无法根除这些肿瘤细胞。在这方面,肝移植和全身治疗可能是预防术后复发的解决方案。因此,确定肝硬化的严重程度以选择合适的手术方式,如肝移植或肝切除术用于HCC,并将新出现的免疫相关辅助和/或新辅助治疗纳入HCC肝切除术策略,已成为优化肝切除术策略的新探索方向。在这个新领域,HCC肝切除术已从一个强调解剖切除的纯技术概念演变为一个包含技术考量以及潜在肝硬化、血管侵犯和全身治疗方面科学进展的科学概念。通过引入科学肝切除术的概念,肝切除术的适应症、时机和手术技术将针对个体患者进一步科学优化,复发率将降低,长期生存率将进一步延长。

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