Percutaneous Radiofrequency Ablation Versus Repeat Hepatectomy for Recurrent Hepatocellular Carcinoma: A Retrospective Study

Background  Whether percutaneous radiofrequency ablation (PRFA) is as effective as repeat hepatectomy for recurrent small hepatocellular carcinoma (HCC) in the long-term remains unknown. Methods  We included 110 patients into this study. Each patient had fewer than three recurrent HCCs, with the largest tumor less than 5 cm in diameter. Sixty-six patients with 88 tumors were treated by PRFA and 44 patients with 55 tumors were treated by repeat hepatectomy. Results  The 1-, 2-, 3-, 4-, and 5-year overall survival rates after repeat hepatectomy and PRFA were 78.6%, 56.8%, 44.5%, 30.7%, and 27.6%, and 76.6%, 48.6%, 48.6%, 39.9%, and 39.9%, respectively (P = 0.79). The 1-, 2-, 3-, 4-, and 5-year overall survival rates after the initial hepatectomy for the two groups were 95.4%, 79.1%, 65.0%, 50.4%, and 42.9%, and 98.5%, 85.0%, 70.8%, 58.7%, and 55.6%, respectively, (P = 0.18). Subgroup analyses showed that there was no significant difference between the overall survivals of the two groups of patients when the interval of tumor recurrence from the initial hepatectomy was ≤1 year (P = 0.74) or >1 year (P = 0.69), and for recurrent tumor ≤3 cm (P = 0.62) or >3 cm (P = 0.57). Major complications happened significantly more often after repeat hepatectomy than PRFA (30 of 44 versus 2 of 66, P < 0.05). The interval of recurrence from the initial hepatectomy, the diameter of the recurrent tumor and the serum albumin level were significant prognostic factors for overall survival. Conclusion  PRFA was as effective as repeat hepatectomy in the treatment of recurrent small HCC. PRFA had the advantage over repeat hepatectomy in being less invasive.     

Percutaneous Radiofrequency Ablation versus Partial Hepatectomy for Multicentric Small Hepatocellular Carcinomas: A Nonrandomized Comparative Study

Background  

The aim of this study was to compare the results of percutaneous radiofrequency ablation (RFA) with those of partial hepatectomy (PH) in the treatment of multicentric small hepatocellular carcinomas (HCCs). With advances in RFA, it is not known whether the minimally invasive approach with percutaneous RFA could attain comparable survival outcomes but with a lower morbidity in patients with multicentric HCCs.     

Survival Analysis of Re-resection Versus Radiofrequency Ablation for Intrahepatic Recurrence After Hepatectomy for Hepatocellular Carcinoma

Background  

Tumor recurrence after resection of hepatocellular carcinoma is a common phenomenon. Re-resection and radiofrequency ablation (RFA) are good options for treating recurrent HCC. This study compared the efficacy of these two modalities in the treatment of intrahepatic HCC recurrence after hepatectomy.     

Percutaneous Radiofrequency Ablation for Recurrent Hepatocellular Carcinoma After Hepatectomy: Long-term Results and Prognostic Factors

Background We evaluated the long-term survival results and safety of percutaneous radiofrequency ablation (RFA) for recurrent hepatocellular carcinoma (HCC) after hepatectomy, and assessed the prognostic factors that can influence its long-term therapeutic results. Methods One hundred and two patients, who had 119 recurrent HCC in their livers, underwent ultrasound-guided percutaneous RFA. All the patients had a history of hepatic resection as a first-line treatment modality for HCC. The mean diameter of the recurrent tumors was 2.0 cm (range, 0.8–5.0 cm). We evaluated the effectiveness rates, local tumor progression rates, survival rates, and complications. We also assessed the prognostic factors of the survival rates by using Cox proportional hazard models. Results The primary effectiveness rate was 93.3% (111 of 119). The cumulative rates of local tumor progression at 1, 3, and 5 years were 6.0, 8.6, and 11.9%, respectively. The cumulative survival rates at 1, 2, 3, 4, and 5 years were 93.9, 83.7, 65.7, 56.6, and 51.6%, respectively. Patients with a lower serum α-fetoprotein (AFP) level (≤100 μg/L) before RFA or with small resected tumors (≤5 cm) demonstrated better survival results (P < .05). There was only one major complication (liver abscess, 1.0% per treatment) during the follow-up period. There were no procedure-related deaths. Conclusions Percutaneous RFA is an effective and safe treatment modality for intrahepatic recurrent HCC after hepatectomy. Serum AFP level before RFA and resected tumor size were significant prognostic predictors of long-term survival.     

R1 Hepatectomy With Exposure of Tumor Surface for Centrally Located Hepatocellular Carcinoma

Background

Hepatectomy with exposure of tumor surface (a special type of R1 resection) provides a chance of cure for selected patients with centrally located hepatocellular carcinoma (HCC) that is adherent to or compresses major vessels. However, the operative indications, safety, and patient outcomes are not well defined.

Methods

We performed hepatectomy for removal of complex centrally located HCC using a selective and dynamic region-specific vascular occlusion technique. Between May 2006 and March 2012, a total of 118 patients underwent resection with exposure of tumor surface (exposure group) and 169 underwent conventional hepatectomy (without exposure of the tumor and vascular surface). The short- and long-term outcomes of patients were evaluated and compared.

Results

The postoperative recovery of liver function was comparable between the two groups. Bile leakage occurred in five patients, all in the exposure group. The 1-, 3-, and 5-year recurrence-free survival rates were 74.4, 45.6, and 30.1 % in the exposure group and 80.9, 57.2, and 31.7 % in the control group (p = 0.041). Corresponding overall survival rates were 92.3, 70.3, and 44.9 % in the exposure group and 97.8, 81.4, and 53.1 % in the control group (p = 0.094).

Conclusions

Hepatectomy with exposure of tumor surface is technically demanding, but can be performed safely. It is also associated with a risk of tumor recurrence. Multidisciplinary combined therapy would be the solution and can contribute to improve overall survival.     

Surgical Resection Versus Radiofrequency Ablation in the Treatment of Small Unifocal Hepatocellular Carcinoma

Background  Hepatocellular carcinoma (HCC) has a high worldwide prevalence and mortality. While surgical resection and transplantation offers curative potential, donor availability and patient liver status and comorbidities may disallow either. Interventional radiological techniques such as radiofrequency ablation (RFA) may offer acceptable overall and disease-free survival rates. Materials and Methods  Sixty-eight cirrhotic patients matched for age, sex, tumor size, and Child–Pugh grade with small (1–5 cm) unifocal HCC were studied retrospectively to find determinants of overall and disease-free survival in those treated with surgical resection and RFA between 1991 and 2003. Results  Multivariate analysis using Cox proportional regression modeling showed that overall survival was related to tumor recurrence (p = 0.010), tumor diameter (p = 0.002), and treatment modality (p = 0.014); overall p = 0.008. Recurrence was independently related to the use of RFA over surgery (p = 0.023) on multivariate analysis; overall p = 0.034. Conclusion  Surgical resection offers longer disease-free survival and potentially longer overall survival than RFA in patients with small unifocal HCC.     

Radical but Conservative Liver Resection for Large Centrally Located Hepatocellular Carcinoma: The Mini Upper-Transversal Hepatectomy

Background

In patients with hepatocellular carcinoma (HCC) in a diseased liver, surgery should be offered in a parenchyma-sparing fashion. This approach seems unfeasible for large and deeply located lesions. Ultrasound study of the tumor-vessel relationship and hepatic inflow and outflow opens new technical solutions: herein is described a new operation based on this approach.1 ^– 3

Methods

A 69-year-old man with a large centrally located HCC (Barcelona Clinic Liver Cancer stage C) underwent surgery. The HCC was located in segments 7, 8, and part of 5, extensively compressing and dislodging the anterior (P5–8) and posterior (P6–7) Glissonean pedicles at their origin. The lesion involved the right hepatic vein (RHV) and was in contact with the middle hepatic vein at the caval confluence. An inferior RHV (IRHV) was preoperatively evident.

Results

After a J-shaped thoracophrenolaparotomy, the liver exploration with the aid of intraoperative ultrasound confirmed the tumoral contact without vascular invasion with P5–8 and P6–7 and disclosed multiple communicating veins between the middle hepatic vein and RHV, warranting with the IRHV the segment 5–6 outflows. A resection of segments 7 and 8 with RHV resection, together with complete tumor detachment from P5–8 and P6–7, was performed. The specimen was removed combining the crush-clamping method for the parenchyma division and a peeling-off technique by means of blunt scissor dissection for the tumor vessel detachment. The postoperative course was uneventful. The patient was alive without recurrence at 12 months after surgery.

Conclusions

This video is the first live demonstration of the previously reported radical but conservative policy, adding to the latter the technical solutions provided by detection of accessory veins such as the IRHV and communicating veins.1 ^– 4     

Radiofrequency Ablation for Subcapsular Hepatocellular Carcinoma

Background: Limited data from recent studies suggested an increased risk of bleeding complications, needle-track seeding, and local recurrence after radiofrequency ablation (RFA) of subcapsular hepatocellular carcinoma (HCC).Methods: Between May 2001 and October 2002, 80 patients underwent RFA of 104 HCC nodules. Forty-eight patients had subcapsular HCC (group I), whereas the other 32 patients did not have subcapsular HCC (group II). RFA was performed via celiotomy, laparoscopy, or a percutaneous approach. Subcapsular HCCs were ablated by indirect puncture through nontumorous liver, and the needle track was thermocoagulated.Results: There were no significant differences between groups in treatment morbidity (14.6% vs. 15.6%; P = .898), mortality (2.1% vs. 0%; P = 1.000), complete ablation rate after a single session (89.4% vs. 96.9%; P = .392), local recurrence rate (4.3% vs. 12.5%; P = .216), recurrence-free survival (1 year: 60.9% vs. 49.2%; P = .258), or overall survival (1 year: 88.3% vs. 79.4%; P = .441). After a median follow-up of 13 months, no needle-track seeding or intraperitoneal metastasis was observed.Conclusions: This study shows that the results of RFA for subcapsular HCCs are comparable to those of RFA for nonsubcapsular HCCs. Subcapsular HCC should not be considered a contraindication for RFA treatment.     

Endoscopic versus Open Radiofrequency Ablation for Treatment of Small Hepatocellular Carcinoma

Background

Surgical radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is associated with superior oncological outcome in comparison with percutaneous RFA. The present study aimed to retrospectively evaluate the relative perioperative safety and postoperative outcome of the laparoscopic or thoracoscopic approach versus the open approach to RFA for small HCC.

Methods

A retrospective analysis was performed in 55 consecutive patients who underwent open (n = 32) or laparoscopic/thoracoscopic (LTS) RFA (n = 23) for primary unresectable HCC between January 2005 and December 2010. Baseline characteristics, survival/recurrence rates, and complications after treatment were compared between the two groups.

Results

There was a trend showing that LTS RFA was performed for tumors located in the anterior segment (e.g., segments III, V, VIII). The LTS RFA group had a significantly lower intraoperative blood loss, shorter operative time, and shorter postoperative hospital stay, compared with the open RFA group. No major postoperative complications occurred in patients who underwent LTS RFA. No significant differences in overall survival, recurrence-free survival and local recurrence rates were observed between the two groups.

Conclusions

In consideration of operative invasiveness and postoperative recovery, LTS RFA is superior to the open approach in patients with small HCC. Moreover, the surgical outcome did not differ between the two approaches. Laparoscopic/thorascopic RFA can be considered to be a useful procedure for ablation therapy.     

Radiofrequency Ablation Versus Surgical Resection for the Treatment of Hepatocellular Carcinoma in Cirrhosis

Background and Aims Percutaneous radiofrequency ablation (RFA) demonstrated good results for the treatment of hepatocellular carcinoma (HCC) in cirrhotic patients; it is still not clear whether the overall survival and disease-free survival after RFA are comparable with surgical resection. The aims of this study are to compare the overall survival and disease-free survival in two groups of cirrhotic patients with HCC submitted to surgery or RFA. Methods Two hundred cirrhotic patients with HCCs smaller than 6 cm were included in this retrospective study: 109 underwent RFA and 91 underwent surgical resection at a single Division of Surgery of University of Verona. Results Median follow-up time was 27 months. Overall survival was significantly longer in the resection group in comparison with the RFA group with a median survival of 57 and 28 months, respectively (P = 0.01). In Child–Pugh class B patients and in patients with multiple HCC, survival was not significantly different between the two groups. In patients with HCC smaller than 3 cm, the overall survival and disease-free survival for RFA and resection were not significantly different in univariate and multivariate analysis. Whereas in patients with HCC greater than 3 cm, surgery showed improvement in outcome in both univariate and multivariate analysis. Conclusions Surgical resection significantly improves the overall survival and disease-free survival in comparison with RFA. In a selected group of patients (Child–Pugh class B, multiple HCC, or in HCC ≤3 cm), the results between the two treatments did not show significant differences.     

Laparoscopic and Thoracoscopic Partial Hepatectomy for Hepatocellular Carcinoma

Several trials have been reported examining laparoscopic liver resections for the treatment of various kinds of liver tumors. However, there are no detailed reports on the use of laparoscopic (LH) and thoracoscopic (TH) hepatectomy for the treatment of hepatocellular carcinoma (HCC). Eleven laparoscopic and thoracoscopic partial liver resections were attempted for treating HCC. The indications for performing a laparoscopic or thoracoscopic partial hepatectomy were as follows: (1) the tumor was located on the surface of the liver; (2) the tumor was less than 3 cm in diameter; and (3) the tumor was not located adjacent to any large vessels. A TH was performed if the tumor was located in segment 8; an LH was performed if the tumor was located in segment 3, 4, or 5. Hand-assisted operations were performed in two patients. The mean operating time was 186.1 ± 44.0 minutes (range 130–310 minutes). The operative blood loss was 218.3 ± 197.6 ml (range 20–650 ml). The mean postoperative hospital stay was 11.3 ± 5.7 days (range 7–26 days). Two patients experienced postoperative complications (wound infection and ascites). No local recurrences have occurred to date. The overall 5-year survival rate and disease-free 5-year survival rate were 75.0% and 38.2%, respectively. Laparoscopic and thoracoscopic hepatic resections are less invasive than conventional surgical techniques and are useful for treating HCC in select patients.     

腹腔镜与开腹手术治疗肝细胞癌疗效的Meta分析

目的系统评价腹腔镜与开腹手术治疗肝细胞癌的疗效。方法计算机检索PubMed、中国期刊全文数据库、万方数据库、中国博硕士学位论文数据库及中国重要会议论文数据库2000～2011年发表的有关腹腔镜肝切除术和开腹肝切除术治疗肝细胞癌的相关文献,采用RevMan 5.0进行Meta分析。结果共纳入11项临床对照试验,包括781例患者,其中经腹腔镜手术治疗325例,开腹手术治疗456例。Meta分析结果显示,与开腹手术相比较,腹腔镜肝切除术能明显缩短手术时间〔加权均数差值（WMD）=-20.85,95%CI（-29.54,-12.16）,P〈0.000 01〕,减少术中出血量〔标准化均数差值（SMD）=-0.42,95%CI（-0.65,-0.19）,P=0.000 4〕,降低术后并发症发生率〔优势比（OR）=0.43,95%CI（0.28,0.65）,P〈0.000 1〕,缩短住院时间〔WMD=-4.32,95%CI（-6.29,-2.34）,P〈0.000 1〕。但术后复发率（P=0.80）和术后1年总生存率（P=0.98）、3年总生存率（P=0.41）、5年总生存率（P=0.12）以及1年无瘤生存率（P=0.15）、3年无瘤生存率（P=0.62）和5年无瘤生存率（P=0.99）差异均无统计学意义。结论对于病变位于CouinaudⅡ、Ⅲ、Ⅳ、Ⅴ及Ⅵ段,其直径小于5 cm,并且不影响第一和第二肝门血管的暴露,肝功能在Child B级以上的肝细胞癌患者,在条件允许的情况下可优先考虑腹腔镜肝切除术。     

Anatomic Versus Nonanatomic Hepatectomy for a Solitary Hepatocellular Carcinoma

Background

It remains controversial whether anatomical resection (AR) improves the prognosis for hepatocellular carcinoma (HCC) or not. To our knowledge, there have been a few well-matched studies about this issue. The aim of the present study was to compare the recurrence-free survival of AR versus nonanatomical resection (NAR) for a solitary HCC using propensity score matching.

Methods

The present study included 236 patients who had a solitary HCC without macroscopic vessel thrombosis. Those patients were divided into AR (n?=?139) and NAR (n?=?97) groups. A propensity score matching was performed to minimize the effect of potential confounders.

Results

Sixty-four patients from each group were matched. Preoperative confounding factors were balanced between the two groups. The median recurrence-free survival times in the AR and NAR groups were 33.8 and 30.8 months, respectively (P?=?0.520). There were no significant differences in the intrahepatic recurrence pattern (P?=?0.097). Operative procedure was not a significant risk factor for recurrence in both uni- and multivariate analyses.

Conclusions

This case-matching study using a propensity score shows that there is no superiority of AR to NAR relevant to the recurrence-free survival in patients with a single HCC.     

Salvage Hepatectomy for Local Recurrent Hepatocellular Carcinoma After Ablation Therapy

Background

The results of salvage hepatectomy for local recurrent hepatocellular carcinoma after incomplete percutaneous ablation therapy are still unclear.

Methods

We conducted a retrospective analysis of 197 consecutive patients with hepatocellular carcinoma who underwent either salvage hepatectomy after prior incomplete percutaneous ablation therapy (salvage group; n?=?23) or primary hepatectomy as the initial treatment (primary group; n?=?174). The two groups were compared with respect to intraoperative data, operative mortality and morbidity, and long-term survival.

Results

The salvage group showed a significantly longer operation time (385 vs. 300?min; P?=?0.006) and a significantly greater intraoperative blood loss volume (402 vs. 265?ml; P?=?0.024). The postoperative mortality rate was zero in both groups, and the morbidity rates were similar. Although the 1-, 3-, and 5-year disease-free survival rates after hepatectomy were significantly worse in the salvage group than in the primary group (65%, 41%, and 33% vs. 81%, 51%, and 45%, respectively; P?=?0.031), the overall survival rates after hepatectomy did not differ significantly (91%, 91%, and 67% vs. 96%, 79%, and 65%, respectively; P?=?0.790). The 1-, 3-, and 5-year overall survival and disease-free survival rates after percutaneous ablation therapy were also not different from those in the primary group (100, 96, and 83%, P?=?0.115; and 96, 60, and 45%, P?=?0.524, respectively).

Conclusions

The short-term and long-term results of salvage hepatectomy after incomplete percutaneous ablation therapy are equivalent to those of primary hepatectomy. Salvage hepatectomy is an acceptable treatment for patients with local recurrence of hepatocellular carcinoma after ablation therapy.     

原发性肝癌术后复发的射频和无水酒精治疗

目的 比较原发性肝癌术后复发患者的射频（RF）治疗和无水酒精注射（PEI）治疗，探讨RF治疗的疗效。方法 回顾性分析我院诊断为原发性肝癌并行根治性手术治疗后肝内复发但没有肝外转移的患者137例，共161个病灶，除外肝功能为ChildC级的患者。分别行RF治疗74例，共86个病灶；行PEI治疗63例，共75个病灶。RF组中有9个病灶直径大于3cm（最大的肿瘤直径为4cm），平均为2．05cm；而PEI组所有病灶直径均小于3cm，平均为2．03cm。监测2组病例治疗前后血常规、肝功能、AFP、彩色多谱勒超声等变化，并统计患者的1、2及3年生存率。结果 RF组和PEI组均未出现严重并发症，RF组和PEI组的肿瘤完全坏死率分别为93．0％（80／86）及81．3％（61／75），前者明显高于后者（P〈0．05）；在RF组中，直径〈3cm和3～4cm的病灶的完全坏死率分别为96．1％（74／77）和66．7％（6／9），前者明显高于后者（P〈0．05）；RF组和PEI组的1、2和3年生存率分别为74．3％（55／74）、62．2％（46／74）及54．8％（17／31）和68．3％（43／63）、57．1％（36／63）及45．0％（9／20），差异均无统计学意义（P〉0．05）；RF组的病灶完全坏死平均治疗次数为1．3次，明显低于PEI组的2．5次（P=0．000）。结论 RF是原发性肝癌术后复发的有效治疗方法之一。     

Impact of Glissonean Pedicle Approach for Centrally Located Hepatocellular Carcinoma in Mongolia

Approaches to surgical resection of centrally located HCC remain controversial. Traditionally, hemi- or extended hepatectomy is suggested. However, it carries a high risk of postoperative complications in patients with cirrhosis. An alternative approach is Glissonean pedicle transection method. This study was conducted to assess the surgical and survival outcomes associated with central liver resection using the Glissonean pedicle transection. Sixty-nine patients with centrally located HCC were studied retrospectively. They were divided into conventional approach group with hemi- or extended hepatectomy, and Glissonean approach group with multisegmental central liver resection using the Glissonean pedicle transection. Glissonean pedicle transection method has comparable or superior surgical and survival outcomes to conventional hemi- or extended hepatectomy with regard to intraoperative bleeding, complications, hospital stay, and postoperative mortality and survival outcomes in patients with centrally located HCC. The 1-, 3-, and 5-year overall survival rates of the conventional approach group were 74%, 64%, and 55% respectively. For the Glissonean approach group, the 1 and 3-year overall survival rates were 86% and 61%, respectively. Glissonean pedicle transection method is a safe and effective surgical procedure in patients with centrally located HCC.Key words: Centrally located HCC, Glissonean approach, Glissonean pedicle transection, Central hepatectomyHepatocellular carcinoma (HCC) is the first leading cause of cancer-related mortality in both men and women in Mongolia, and its incidence is among the highest worldwide.¹ Surgical resection remains the first-line therapeutic strategy for HCC despite recent advancements in treatment modalities.^2-4 However, underlying liver diseases significantly limit the number of HCC patients eligible for surgical resection. This is especially problematic, where the prevalence of chronic hepatitis B and C is over 10% in the general population, and 86.8% of HCC patients have cirrhosis.⁵ Therefore, refining surgical techniques to preserve as much liver parenchyma as possible could potentially improve treatment prospects for cirrhotic HCC patients, particularly in cases when the tumor is centrally located.Traditionally, hemi- or extended hepatectomy is suggested for the treatment of centrally located HCC.⁶ However, such a major hepatic resection sacrifices a large volume of noncancerous liver parenchyma, which carries a high risk of postoperative liver failure in patients with cirrhotic background.^6-8 Preservation of functioning liver parenchyma to a maximum extent possible is crucial to avoid postoperative liver failure in cirrhotic patients. Therefore, Glissonean pedicle transection method is increasingly considered as an effective alternative to hemi- or extended hepatectomies in such cases.^9-16 Nonetheless, multisegmental central liver resection has not been widely used since its introduction for gallbladder cancer in 1972.^17,18 Conventional central liver resection method is technically demanding, and may require prolonged surgical time in order to dissect and confirm each branch of hepatic artery, portal vein, and bile duct to the anterior section.^19,20 This often results in increased risk of bleeding, bile leakage or parenchymal necrosis, and therefore, central liver resection particularly in cirrhotic patients remains controversial.^21,22 The answer to the dilemma could lie with the Glissonean pedicle transection method, which was introduced in the mid-1980s owing to a better understanding of the surgical anatomy of the liver.^20,23 When using this resection method, Glissonean pedicle supplying the target area is ligated and divided at the hepatic hilum prior to resection without exposing the vessels individually.²³ This simplifies hepatic resection, shortens operation time and reduces intraoperative bleeding.²³⁻²⁵ Our previous experience with using this method for hemihepatectomy has resulted in considerable reduction of blood loss during resection, a major determinant of patient outcome.This approach has allowed the ability to adapt the size of resection to the extent of the tumor and to preserve the maximum amount of liver parenchyma, which is crucial for the prevention of postoperative liver failure especially in patients with cirrhotic background. However, it remains unclear whether central liver resection using the Glissonean pedicle transection improves long-term survival. Therefore, the current retrospective study of patients with centrally located HCC, who underwent either hemi- or extended hepatectomy or multisegmental central liver resection, was conducted to assess the perioperative and long-term outcomes associated with central liver resection using the Glissonean pedicle transection.     

小肝癌射频消融治疗后患者生存及肝内肿瘤复发的有关因素分析

目的探讨射频消融(radiofrequency ablation,RFA)对≤5cm肝细胞癌(hepatocellular carcinoma,HCC)的疗效。方法2001年6月~2008年4月,对94例≤5cm的HCC进行了135次冷循环射频消融治疗,治疗途径包括超声引导下经皮穿刺(n=102),开腹(n=22),人工胸水辅助超声引导(n=11)。术后随访资料采用Kaplan-Meier模型分析患者的生存情况、肿瘤复发情况及其影响因素。结果射频消融术后1、2、3年的累计生存率分别为88.8%、72.2%、68.4%。45例术后1.5~36个月出现肝内复发,患者1、2、3年的无瘤生存率分别为58.8%、41.3%、28.1%。单因素分析显示:生存时间与肝功能Child-Pugh分级和血清甲胎蛋白水平有关(χ2=6.37,P=0.012;χ2=5.76,P=0.016);肝硬化、肝内多发病灶和高血清甲胎蛋白水平可能是术后肝内复发的危险因素(χ2=3.87,P=0.049;χ2=4.50,P=0.034;χ2=4.28,P=0.039)。结论对≤5cm的HCC,RFA是一种有效治疗方法。     

射频消融在肝细胞肝癌根治性治疗中的临床价值

目的探索射频消融术（RFA）在肝细胞肝癌（简称肝癌）根治性治疗中的临床应用价值。方法检索近年来有关RFA在肝癌治疗中应用的文献并进行综述。结果肝脏移植、肝切除术和RFA是目前被认为具有治愈性治疗效果的3种方法,其中RFA由于具有较好的局部肿瘤控制效果,近年来较多地用于肝脏移植术前的减瘤治疗,在延长患者的等待期的同时不增加病例脱落及死亡的危险。虽然RFA与肝脏切除术对小肝癌的疗效目前尚有争论,但是RFA联合肝脏切除术,扩大了肝癌患者的手术指征,提高了疗效。结论由于RFA技术良好的局部肿瘤控制能力和微创特点,使其在肝癌的各种治疗策略中发挥越来越重要的作用,并与肝移植及肝部分切除术的优点相互补充,使更多的肝癌患者受益。无论是哪一种治疗方法,术中最大程度地减少残癌的发生率,术后密切随访,复发后积极地治疗才是提高疗效的根本。