Surgery for Hepatocellular Carcinoma in Patients with Child–Pugh B Cirrhosis: Hepatic Resection Versus Living Donor Liver Transplantation

World Journal of Surgery - 2018
Norifumi Harimoto1, Tomoharu Yoshizumi1, Yoshiaki Fujimoto1, Takashi Mizutani1, Youhei Mano1, Takeo Toshima1, Shinji Itoh1, Noboru Harada1, Toru Ikegami1, Hideaki Uchiyama1, Yuji Soejima1, Yoshihiko Maehara1
1Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Tóm tắt

AbstractBackgroundLiver transplantation has been established as the optimal treatment for hepatocellular carcinoma in cirrhotic patients, but hepatic resection is also effective in patients with well‐preserved liver function. Determining the suitable surgical treatment for patients with Child–Pugh class B cirrhosis is a more difficult challenge. MethodsWe retrospectively compared the results of hepatic resection and living donor liver transplantation for hepatocellular carcinoma in 137 patients with Child–Pugh class B cirrhosis. The procedures were performed at Kyushu University Hospital from April 2014 through October 2016.ResultsPatients who underwent hepatic resection were significantly older and had better liver function, larger tumor size, smaller number of tumors, and less surgical stress compared with patients who underwent living donor liver transplantation. The overall survival rate and the recurrence‐free survival rate in patients with transplantation were significantly better than that in patients with resection. The multivariate analysis showed that recurrent hepatocellular carcinoma and microvascular invasion were significant prognostic factors for both overall and recurrence‐free survival in the hepatic resection group. In the group with protein induced by vitamin K absence or antagonist‐II ≥300 mAU/mL, both the overall survival curve and the recurrence‐free survival curve in patients with living donor liver transplantation were not significantly different from those in patients with hepatic resection.ConclusionsLiving donor liver transplantation for hepatocellular carcinoma in patients with Child–Pugh class B cirrhosis was favorable under the condition of protein induced by vitamin K absence or antagonist‐II <300 mAU/mL in selected recipients and donors. Hepatic resection for recurrent hepatocellular carcinoma and excessive blood loss should be avoided in patients with Child–Pugh class B cirrhosis.

Từ khóa


Tài liệu tham khảo

10.1016/S0140‐6736(03)14964‐1

10.1159/000048269

10.1097/00000658‐199801000‐00012

10.1053/gast.1996.v111.pm8780578

10.1097/01.sla.0000094549.11754.e6

10.1016/j.surg.2006.12.014

10.1056/NEJM199603143341104

10.1053/he.2000.6959

10.1053/jhep.2002.32089

10.1097/00000658‐199308000‐00005

10.1002/hep.510280222

10.1016/S0168‐8278(97)80462‐X

10.1111/tri.12297

10.1002/lt.23605

10.1097/MD.0000000000005756

10.1097/01.sla.0000133083.54934.ae

10.1002/lt.20537

10.1016/j.jamcollsurg.2007.01.069

10.1007/s11605‐008‐0588‐6

10.1016/j.jamcollsurg.2010.04.018

Liver cancer study group of Japan, 2003, General rules for the clinical and pathological study of primary liver cancer, 34

10.1016/S1470‐2045(08)70284‐5

10.1097/TP.0b013e3181943bee

10.1097/TP.0b013e3182a53f2b

10.1016/j.jhep.2012.08.017

10.1016/j.transproceed.2007.06.042

10.1007/PL00009947

10.1002/lt.22047

10.1245/s10434‐010‐0999‐y

10.1002/lt.20128

10.1200/JCO.1999.17.1.324

10.1002/1097‐0142(19911115)68:10<2095::AID‐CNCR2820681002>3.0.CO;2‐Y

10.1002/lt.23804

10.1016/j.jamcollsurg.2011.12.001

10.1016/j.transproceed.2014.09.178

10.1002/bjs.1800730606

10.1002/lt.24111

10.12659/AOT.883689

Thông tin
Thông tin xuất bản

World Journal of Surgery

Thông tin tác giả