Hepatic Resection for Hepatocellular Carcinoma - Results and Analysis of the Current Literature

作者：Neeff H; Makowiec F^*; Harder J; Gumpp V; Klock A; Thimme R; Drognitz O; Hopt U T

来源：Zentralblatt fur Chirurgie, 2009, 134(2): 127-135.

DOI：10.1055/s-0028-1098881

• hepatocellular carcinoma
• liver resection
• survival
• postoperative complication

Background: Hepatocellular carcinoma (HCC) is the fifth-leading cause of cancer death worldwide. Although less frequent in Western Europe, its incidence is increasing in this region. Causes involved in the pathogenesis of HCC are, besides viral hepatitis, metabolic and nutritional factors (alcohol, diabetes, obesity). The therapeutic management depends strongly on the initial extent of disease and includes hepatic resection, liver transplantation and local ablation. In this context, we present our results on liver resection for HCC and a discussion of the current literature about (potentially curative) treatment for HCC.
Patients: From 1999 until 2008 93 patients [83% male, median age 64 (range: 39-94) years] underwent hepatic resection for HCC. Postoperative follow-up was available in 85 patients [median follow-up: 1.2 (0.25-8) years].
Results: In contrast to data, especially from Asia, a viral hepatitis as the origin of HCC was found in only 28% of the patients in our series. Half of the patients had proven liver cirrhosis. The median number of intrahepatic tumours was one (1-11), median size of the largest tumour was 55 mm (5-250 mm). 58% of the HCC were removed by atypical or segmental resection, 42% of the patients underwent hemihepatectomy or extended hemihepatectomy. Tumor-free resection margins were achieved in 95%. Total postoperative morbidity was 61%. A reoperation for complications was necessary in 10%. Hospital mortality was 8.6% in the entire study period but decreased from 14.9% in 1999-2004 to 2.2% in 2005 to 2008 (p = 0.03). Actuarial survival was 81% after 1 year, 58% after 3 years and 26% after 5 years. The T-stage could be identified tendentially as a prognostic factor influencing survival.
Conclusion: With the proper selection of patients, liver resection for HCC may be performed with a curative intention (i.e., free resection margins) in over 90%. Although it decreased during the study period peri-operative mortality was higher than after resection of other hepatic tumours. Long-term survival in our series was comparable to reports from other European centres.

• 出版日期2009-4