原发性肝癌术后肝内复发与肝外转移再手术切除疗效分析

An Analysis of the Effect of Re-resection for Intrahepatic Recurrent Cancer and Extrahepatic Metastases of Primary Hepatocellular Carcinoma

[目的]探讨原发性肝癌术后肝内复发与肝外转移再手术切除的疗效。[方法]回顾性分析267例再切除的复发性肝癌患者的临床资料,其中205例行再次肝切除,51例行肝外转移癌切除,11例行肝内复发和肝外转移癌联合切除,比较其临床病理特征和生存率。[结果]肝内复发组第二次手术后1年,3年,5年和10年生存率为81.7%,42.2%,20.0%和10.0%,第三次手术后为78.3%,30.4%,13.0%和8.7%。中位生存时间为44个月。肝外转移组第二次手术后为80.4%,32.0%,16.0%和4.3%,第三次手术后为76.0%,27.9%,13.6%和0。中位生存时间为43个月。肝内复发联合肝外转移切除组总的1年,3年,5年和10年生存率为100.0%,72.7%,36.4%和0。肝内复发组与肝外转移组再切除术后生存率的比较差异无显著性(P>0.05)。[结论]再手术切除不仅适用于肝内复发,还可有选择适用于肝外转移。肝外转移再切除也能延长生存期。

To evaluate the effect of re-resection for intrahepatic recurrent cancer and extrahepatic metastases of primary hepatocellular carcinoma.The clinical data of 267 patients with recurrent liver cancer after re-resection were retrospectively analyzed, 205 cases were performed with resection of intrahepatic recurrent cancer, 51 cases with resection of extrahepatic metastases and 11 cases with combined resection of intrahepatic recurrent cancer and extrahepatic metastases.Their clinico-pathologic features and survival were analyzed. In the re-resection of intrahepatic recurrent cancer group,the 1, 3, 5 and 10-year survival rate after second resection was 81.7%, 42.2%, 20.0% and 10.0% respectively, while 78.3%, 30.4%, 13.01% and 8.7% respectively after the third resection.The median survival time was 44 months.In the re-resection of extrahepatic metastases group, the 1, 3, 5 and 10-year survival rate after second resection was 80.4%, 32.0%, 16.0% and 4.3% respectively, while 76.0%, 27.9%, 13.6% and 0 respectively after the third resection. The median survival time was 43 months. The 1, 3, 5 and 10-year survival rate was 100.0%,72.7%,36.4% and 0 respectively in the intrahepatic recurrent and extrahepatic metastases group.The survival was no significantly difference between intrahepatic recurrent and extrahepatic metastases groups (P>0.05). [Conclusions] The re-resection can be applicable not only to intrahepatic recurrent cancer but also to extrahepatic metastases in certain selected patients. The re-resection with extrahepatic metastases also prolongs survival.