| Qing Xiong,Xiaobin Feng,Jun Yan,Feng Xia,Xiaowu Li,Kuansheng Ma,Ping Bie. A clinical study on salvage hepatectomy for treating recurrent liver cancer after radiofrequency ablation. Oncol Transl Med, 2015, 1: 256-260. |
| 补救性肝切除术治疗肝癌射频消融术后局部复发肿瘤的临床研究 |
| A clinical study on salvage hepatectomy for treating recurrent liver cancer after radiofrequency ablation |
| Received:June 29, 2015 Revised:November 22, 2015 |
| DOI：10.1007/s10330-015-0111-y |
| 中文关键词: 肝癌，射频消融术，补救性肝切除术 |
| 英文关键词: liver cancer; radiofrequency ablation (RFA); salvage hepatectomy |
| 基金项目: |
| Author Name | Affiliation | E-mail | | Qing Xiong | Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, | 377599839@QQ.COM | | Xiaobin Feng | Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, | | | Jun Yan | Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, | | | Feng Xia | Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, | | | Xiaowu Li | Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, | | | Kuansheng Ma* | Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, | makuansheng@vip.sina.com | | Ping Bie | Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, | |
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| 中文摘要: |
| 目的：通过对肝癌射频消融术后复发患者行补救性肝切除的临床研究，探索补救性肝切除治疗肝癌射频消融术后复发疗效。方法：回顾分析了西南医院肝胆外科2006年1月-2014年1月间67例肝癌射频消融治疗后复发行补救性肝切除的患者各项指标，包括：性别、年龄、肝炎类型、甲胎蛋白量、射频消融前和补救性肝切除前肿瘤TNM分期、补救性肝切除术后总生存率和无瘤生存率。结果：67例患者中男56例，女11例；年龄为38~78岁，中位年龄56岁；乙肝57例，丙肝2例，无肝炎8例；甲胎蛋白量为3-4521ng/ml之间，中位33ng/ml；射频消融前肿瘤Ⅰ期54例，Ⅱ期12例，肿瘤大小为0.82cm-4.83cm，中位大小为3.0cm；射频次数单次为20例，反复多次射频消融为47例；射频毁损直径3.8-5.2cm，中位大小4.5cm。患者射频消融术后复发行手术切除，间隔时间为3-37个月；补救性肝切除前肿瘤Ⅰ期23例，Ⅱ期12例，Ⅲ期32例，肿瘤大小为4.83-11.84cm，中位大小为6.3cm，开腹有56例，腹腔镜有28例；手术中阻断肝门有39例，阻断时间为15-45分钟；手术持续时间为219-370分钟，术中出血量为100-2100ml，其中术中输血有13例。肿瘤病检提示低中高分化程度分别为31、35和1例。住院期间无术后并发症死亡患者，住院时间为8-10天。1、3、5年生存率和无瘤生存率分别是85%和79%，50%和20%，39%和19%。K-M和COX回归分析得出补救性肝切除前肿瘤数目和大小是影响生存率的危险因素。结论：早期肝癌射频消融术后复发肿瘤肿为Ⅰ期的患者行补救性肝切除术治疗效果较好。 |
| 英文摘要: |
| Objective: We studied the efficacy of salvage hepatectomy for treating recurrent hepatic cancer after radiofrequency ablation (RFA).
Methods: A retrospective analysis of 67 patients who had recurrent liver cancer after RFA treatment and received salvage hepatectomy in the Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (China), from January 2006 to January 2014, was performed. The analysis included patient gender, age, hepatitis type, alpha-fetoprotein (AFP), and TNM stage prior to RFA and salvage hepatectomy, overall urvival rates, and tumor-free survival rates after salvage hepatectomy.
Results: Among the 67 patients, there were 57 cases of hepatitis B, two cases of hepatitis C, and eight cases did not have hepatitis. AFP levels in patients ranged from 3 to 4521 ng/mL (median 33 ng/mL). Before RFA, 54 cases were stage I tumors, and 13 were stage II tumors. Tumor sizes varied from 0.82 to 4.83 cm (median 3.0 cm). In 20 cases, one RFA was performed, and for 47 cases, RFA was repeated. RFAablated region diameters ranged from 3.8 to 5.2 cm (median 4.5 cm). The interval between the salvage surgical resection and RFA was 3–37 months. Before salvage hepatectomy, 23 stage I tumors, 12 stage II tumors, and 32 stage III tumors were present (size ranged 4.83–11.84 cm; median 6.3 cm). For salvage hepatectomy, laparotomy was performed for 56 cases, and laparoscopy was performed for 28 cases. Inflow clamping was performed for 39 cases (15–45 min). Surgery was 219–370 min and intraoperative blood loss was 100–2100 mL. For 13 cases, intraoperative blood transfusion was required. Tumor pathological data revealed 31, 35, and 1 poorly, moderately, and well differentiated tumors, respectively. No patients died due to operative complications, and hospital stays were 8–10 days. Overall and tumor-free survival rates were 85% and 79% for 1 year, 50% and 20% for 3 years, and 39% and 19% for 5 years, respectively. Kaplan-Meier analysis and Cox regression confirmed that tumor number and size prior to salvage liver cancer were risk factors affecting survival.
Conclusion: Patients who received RFA to treat early-stage liver cancer with postoperative recurrent stage I tumors have satisfactory outcomes with salvage hepatectomy. |
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