Sbaï Idrissi M S, Vons C, Borgonovo G, Mariette D, Smadja C, Franco D
Service de Chirurgie Générale et Digestive, Hôpital Antoine-Béclère, Clamart.
Ann Chir. 1998;52(6):543-6.
Between October 1990 and December 1995, 86 patients underwent hepatic resection for hepatocellular carcinoma (HCC). All resections were carried out with the aim of achieving complete cure. Fifty one (60%) of these patients subsequently developed recurrent HCC. Only twenty patients could be treated in our hospital. There were 18 men and 2 women, with a mean age of 61 years at the time of recurrence. Six patients had a normal liver. Fourteen patients had associated liver cirrhosis. using Pugh's classification, 7 patients were Pugh A, 6 Pugh B and 1 Pugh C. The initial hepatic resection had consisted of major hepatectomy in 9 cases and segmentectomy in the remaining 11 patients. The mean time to recurrence was 17 months. There were 3 recurrences on the resection margin and 17 recurrences away from the hepatic stump. The therapeutic choice after hepatic recurrence was based on the number of tumors, hepatic function and the size of the liver remnant. Six patients were treated by tamoxifen due to poor hepatic function; median survival after recurrence was 6 months. Four patients with a single recurrent tumor on an atrophied liver remnant were treated by percutaneous ethanol injection with a median survival after recurrence of 15 months. Five patients with multiple diffuse lesions and good hepatic function were treated by transarterial chemoembolisation with a median survival after recurrence of 30 months. Five patients with a solitary tumor and good hepatic function underwent a second hepatic resection with a median survival after recurrence of 35 months. The overall median survival after diagnosis of recurrence was 20 months. These results suggest that an active treatment should be carried out in cases of recurrence of HCC. A second resection, if technically possible, offers the best chance of survival.
1990年10月至1995年12月期间，86例患者因肝细胞癌（HCC）接受了肝切除术。所有切除术的目的都是实现完全治愈。其中51例（60%）患者随后出现复发性HCC。只有20例患者能在我院接受治疗。男性18例，女性2例，复发时平均年龄61岁。6例患者肝脏正常。14例患者伴有肝硬化。根据Pugh分级，7例为Pugh A级，6例为Pugh B级，1例为Pugh C级。初次肝切除术包括9例肝大部切除术和其余11例患者的肝段切除术。复发的平均时间为17个月。切缘复发3例，肝残端外复发17例。肝复发后的治疗选择基于肿瘤数量、肝功能和肝残余体积。6例因肝功能差接受他莫昔芬治疗；复发后的中位生存期为6个月。4例肝残余萎缩且有单个复发性肿瘤的患者接受了经皮乙醇注射治疗，复发后的中位生存期为15个月。5例有多个弥漫性病变且肝功能良好的患者接受了经动脉化疗栓塞治疗，复发后的中位生存期为30个月。5例有孤立肿瘤且肝功能良好的患者接受了二次肝切除术，复发后的中位生存期为35个月。复发诊断后的总体中位生存期为20个月。这些结果表明，HCC复发时应积极进行治疗。如果技术上可行，二次切除术提供了最佳的生存机会。
