腹腔镜消融治疗小肝癌或肝切除术治疗小肝癌

Laparoscopic ablation therapies or hepatic resection in cirrhotic patients with small hepatocellular carcinoma

Abstract
BACKGROUND:
The Barcelona Clinic Liver Cancer staging system recommends radiofrequency ablation as treatment of choice for patients with "small" (up to 2 cm in size) hepatocellular carcinoma.

AIMS:
Aim of the study was to assess whether laparoscopic ablation therapies or hepatic resection could be proposed as alternative option if percutaneous approach is not feasible.

METHODS:
Overall survival and tumour recurrence rate were compared in a retrospective cohort of 176 consecutive patients with small hepatocellular carcinoma on cirrhosis treated by laparoscopic ablation therapies or surgery. To balance the covariates between the two groups, a propensity case-matched analysis was developed to generate a matched sample, which included 76 patients in each arm.

RESULTS:
Local tumour progression (p=0.005), intra-segmental recurrence (p=0.0001), and 5-year recurrence rates (80% vs. 60%; p=0.0014) were significantly higher in the ablation therapies group. The 5-year survival rate were 48% after ablation therapies and 69% after hepatic resection (p=0.0006). Multivariate analysis showed that MELD score, alpha-fetoprotein value, procedure category and intraoperative restaging were associated with survival, while the surgery was the only independent predictor of intra-hepatic recurrence.

CONCLUSIONS:
The present study suggests that, if percutaneous ablation is not feasible, hepatic resection may be considered as a sound option in the treatment of small hepatocellular carcinoma.

KEYWORDS:
Hepatic resection; Hepatocellular carcinoma; Laparoscopic ablation therapies; Liver cirrhosis

腹腔镜消融治疗小肝癌或肝切除术治疗小肝癌

Fig. 1. Intraoperative patterns of micronvasive hepatocellular carcinoma. Panel (A) confluent multinodular type (black arrow) with satellite (white arrow); panel (B) singlenodular type with satellites (arrow); panel (C) portal venous micro-infiltration (arrow); panel (D) upstream biliary invasion (arrow) with dilatation of biliary ducts. HCC,hepatocellular carcinoma; T, tumour.

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