Resection Margin in Preventing the Intrahepatic Recurrence after Resection of Hepatocellular Carcinoma

切除距離在預防肝細胞癌手術後肝內復發之影響

游朝慶(Chao-Chin Yu) ； 楊美都(Mei-Du Yang) ； 吳建廷(Chen-Teng Wu) ； 鄭隆賓(Long-Bin Jeng)

《Formosan Journal of Surgery》 40卷6期 (2007/12) Pp. 236-242

https://doi.org/10.29833/FJS.200712.0002

摘要

肝腫瘤的手術切除邊緣的重要性一直是爭議性的。
本研究回溯性追蹤從1995年至2003年間手術切除肝細胞癌的202名患者，排除掉日後發生遠處轉移及切除邊緣爲零的患者，這些患者被分爲四組，分別爲切除邊緣小於0.5公分，0.5到0.99公分，1到1.99公分，及大於等於2公分。
結果發現這四組之切除邊緣對存活及復發率的影響不大，當分爲切除邊緣小於或大於等於1公分兩族群，其對存活及復發率的影響同樣不顯著：但若分爲切除邊緣小於或大於等於0.5公分兩族群時，當切除邊緣小於0.5公分，相對就比較容易復發（34人，無病存活期中位數爲8.1個月，P=0.0371），而切除邊緣大於等於0.5公分的群組（168人，其無病存活期中位數爲18.6個月）。
故結論是只要切除邊緣大於等於0.5公分就足以避免肝癌術後早期復發。

並列摘要

Objectives: The extent of the liver resection margin (RM) for hepatocellular carcinoma (HCC) remains controversial. The aim of this study is to re-evaluate the optimal extent of resection.
Methods: After exclusion of extrahepatic recurrence (n=12) or RM=0 cm (n=7), a retrospective review of 202 patients who underwent curative liver resection for primary HCC from May 1995 to Dec 2003 was conducted. These patients were divided into 4 groups according to the RM as＜0.5 cm, 0.5-0.99cm, 1-1.99cm, and≥2cm, respectively. Then the same patients were re-divided into 2 groups as RM＜1cm and≥1cm. We also analyzed the relationship of the 2 groups with RM＜0.5cm and≥0.5cm from the same 202 patients. The difference of intrahepatic recurrence rate and patient survival rate were evaluated by the Kaplan-Meier method and compared by the log-rank test.
Results: Both the RM among the 4 groups and RM＜1cm vs. ≥1cm were not a significant factor related to patient survival or to the intrahepatic recurrence. Patients with a tumor RM less than 0.5cm had a poorer prognosis on intrahepatic recurrence (n=34, median value=8.1 months) than those with a RM greater than or equal to 0.5cm (n=168, median value=18.6 months) (P=0.0371).
Conclusions: RM of greater or equal to 0.5cm is adequate with regard to the prevention of intrahepatic recurrence after resection of HCC.

並列關鍵字

liver resection ； resection margin ； hepatocellular carcinoma ； intrahepatic recurrence