Effect of resection following downstaging of unresectable hepatocelluar carcinoma by transcatheter arterial chemoembolization.

医学 肝细胞癌 围手术期 外科 肝移植 经导管动脉化疗栓塞 回顾性队列研究 移植 内科学
作者
Xianjie Shi,Xin Jin,Maoqiang Wang,Lixin Wei,Huiyi Ye,Yurong Liang,Ying Luo,Jiahong Dong
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期刊:PubMed 卷期号:125 (2): 197-202 被引量:23
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This retrospective study was undertaken to analyze the outcome of hepatic resection in fifty-two patients with unresectable hepatocellular carcinoma (HCC) between January 2004 and December 2008.Among these fifty-two patients, the mean diameter of the tumor was 7.9 cm (4.4 - 15.5 cm, median 8.5 cm) prior to the first transcatheter arterial chemoembolization (TACE). After 1 - 6 times of TACE (median 2), the median tumor diameter was reduced to 4.2 cm (0 - 8.4 cm) prior to resection. The duration between the last TACE treatment and sequential resection varied from one to six months (median 2.7 months). Serum a-fetoprotein (AFP) levels were abnormal in thirty-eight out of the fifty-two patients. In AFP producing HCCs, AFP levels returned to normal (≤ 400 µg/L) in twenty-five out of thirty-eight patients. Hepatic segmentectomy, multiple hepatic segmentectomy or partial hepatic resection were performed in forty-five patients, two underwent extended left hemihepatectomy, and one underwent right posterior branch portal vein thrombectomy. One patient received a right hemihepatectomy and three had left hemihepatectomies.Complete tumor radiological response (CR) occurred in five patients (9.6%). There were three cases of perioperative mortality in the fifty-two patients (5.8%). One patient underwent salvaged orthotopic liver transplantation, and twenty-one patients observed tumor recurrence within two years. The 1-, 3- and 5-year survival rates of the fifty-two patients were 77.0% (n = 40), 55.0% (n = 29), and 52.0% (n = 28), respectively. The median survival time after surgery was 49 months (95% confidence interval 7.5 - 52.7 months).TACE treatment provides a better chance for HCC resection in patients initially diagnosed with unresectable HCC. Furthermore, liver resection should be performed once the tumor is downstaged to be compatible for successful resection.

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