Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa.
Surgical Gastroenterology and HPB Surgery Unit, Groote Schuur Hospital, Observatory, South Africa.
S Afr J Surg. 2024 May;62(2):13-17.
More than 80% of global hepatocellular carcinomas (HCC) occur in sub-Saharan Africa (SSA) and South- East Asia. Compared with the rest of the world, HCC in SSA has the lowest resection and survival rates. This study assessed outcome following liver resection for HCC and fibrolamellar carcinoma (FLC) at a tertiary referral centre in South Africa.
A retrospective analysis was done of all liver resections for HCC and FLC at Groote Schuur Hospital and the University of Cape Town Private Academic Hospital between January 1990 and December 2021. Three groups were compared, (i) HCC occurring in normal livers, (ii) HCC occurring in cirrhotic livers, and (iii) fibrolamellar carcinoma. Postoperative complications were classified as per the expanded accordion severity grading system. Median overall survival (OS) and 95% confidence intervals (CI) were calculated.
Forty-eight patients were included in the study, 25 for HCC in non-cirrhotic livers, 15 in cirrhotic livers and eight for FLC. Thirty-six patients (75%) underwent a major resection. No mortality occurred but 16 patients (33%) developed grade 1 to 4 complications postoperatively. Thirty-three patients (69%) developed recurrence of HCC following their initial resection of whom 29 (60%) ultimately died. Median overall survival (OS) for the total cohort after surgery was 57.2 months, 95% CI (29.7-84.6), 64.2 months (29.7-84.6), 61.9 months (28.1-95.6), and 31.7 months (1.5-61.8) for patients with HCC in non-cirrhotic livers, FLC and HCC in cirrhotic livers respectively.
Liver resection for HCC and FLC was safe with no mortality, but one-third of patients had associated postoperative morbidity. The high long-term recurrence rate remains a major obstacle in achieving better survival results after resection.
超过 80%的全球肝细胞癌 (HCC) 发生在撒哈拉以南非洲 (SSA) 和东南亚。与世界其他地区相比，SSA 的 HCC 切除率和生存率最低。本研究评估了南非一家三级转诊中心行肝切除术治疗 HCC 和纤维板层样癌 (FLC) 的结果。
对 1990 年 1 月至 2021 年 12 月期间在格罗特舒尔医院和开普敦大学私立学术医院行肝切除术治疗 HCC 和 FLC 的所有患者进行回顾性分析。将患者分为三组，(i) 正常肝脏中的 HCC，(ii) 肝硬化肝脏中的 HCC，和 (iii) 纤维板层样癌。根据扩展的 accordion 严重程度分级系统对术后并发症进行分类。计算中位总生存期 (OS) 和 95%置信区间 (CI)。
研究共纳入 48 例患者，其中 25 例为非肝硬化肝脏中的 HCC，15 例为肝硬化肝脏中的 HCC，8 例为纤维板层样癌。36 例患者 (75%) 行根治性切除术。无死亡病例，但术后 16 例 (33%) 发生 1 至 4 级并发症。33 例患者 (69%) 在初始切除后 HCC 复发，其中 29 例 (60%) 最终死亡。总队列术后中位总生存期 (OS) 为 57.2 个月，95%CI (29.7-84.6)，非肝硬化肝脏中 HCC、FLC 和肝硬化肝脏中 HCC 的中位 OS 分别为 64.2 个月 (29.7-84.6)、61.9 个月 (28.1-95.6) 和 31.7 个月 (1.5-61.8)。
肝切除术治疗 HCC 和 FLC 是安全的，无死亡病例，但三分之一的患者术后发生并发症。长期高复发率仍然是影响切除术后生存结果的主要障碍。
