Yang Shiye, Ni Haishun, Zhang Aixian, Zhang Jixiang, Zang Hong, Ming Zhibing
Department of Comprehensive Surgery, Vascular Surgery, Nantong First People's Hospital, Affiliated Hospital 2 of Nantong University, 666 Shengli Road, Chongchuan District, Nantong City, Jiangsu Province, 226014, China.
Department of General Surgery, Nantong Second People's Hospital, 298 Xinhua Road, Gangzha District, Nantong City, Jiangsu Province, 226002, China.
Eur J Surg Oncol. 2025 Jan;51(1):109353. doi: 10.1016/j.ejso.2024.109353. Epub 2024 Oct 31.
To investigate the impact of surgical resection margin and hepatic resection type on prognosis and compare their prognostic significance on patients with hepatocellular carcinoma (HCC) with or without microvascular invasion (MVI) who underwent laparoscopic liver resection (LLR).
A retrospective analysis was conducted on 320 patients with HCC who underwent LLR. According to the grading of MVI, patients were classified as M0, M1 and M2. Patients were divided into the anatomical resection (AR) and nonanatomical resection (NAR) groups according to the hepatic resection type. Survival and Cox regression analyses were performed to explore the effects of AR and NAR, wide and narrow resection margin on overall survival (OS) and time to recurrence (TTR).
In the whole cohort, narrow resection margin was an independent risk factor for OS and TTR, whereas NAR was not. Subgroup analysis showed that narrow resection margin and NAR were both independent risk factors for OS and TTR in HCC patients with MVI. The 5-year OS and TTR rates of the two groups (NAR-wide resection margin and AR-narrow resection margin) with M1 were 85.3 % versus 62 % and 34.4 % versus 60.2 %. Similarly, the 5-year OS and TTR rates of the two groups (NAR-wide resection margin and AR-narrow resection margin) with M2 were 80.2 % versus 47.9 % and 30.8 % versus 64.8 %.
Anatomical hepatectomy and wide resection margin were independent protective factors for HCC patients with MVI receiving LLR. Nonetheless, wide resection margin had a greater impact on prognosis than anatomical hepatectomy.
探讨手术切缘和肝切除类型对接受腹腔镜肝切除术（LLR）的肝细胞癌（HCC）患者预后的影响，并比较它们在有无微血管侵犯（MVI）的HCC患者中的预后意义。
对320例行LLR的HCC患者进行回顾性分析。根据MVI分级，患者分为M0、M1和M2组。根据肝切除类型，患者分为解剖性切除（AR）组和非解剖性切除（NAR）组。进行生存分析和Cox回归分析，以探讨AR和NAR、宽切缘和窄切缘对总生存期（OS）和复发时间（TTR）的影响。
在整个队列中，窄切缘是OS和TTR的独立危险因素，而NAR不是。亚组分析显示，窄切缘和NAR都是MVI的HCC患者OS和TTR的独立危险因素。M1的两组（NAR-宽切缘和AR-窄切缘）的5年OS率和TTR率分别为85.3%对62%和34.4%对60.2%。同样，M2的两组（NAR-宽切缘和AR-窄切缘）的5年OS率和TTR率分别为80.2%对47.9%和30.8%对64.8%。
解剖性肝切除术和宽切缘是接受LLR的MVI的HCC患者的独立保护因素。尽管如此，宽切缘对预后的影响比解剖性肝切除术更大。
