Surgery for Intermediate and Advanced Hepatocellular Carcinoma: A Consensus Report from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014)

被引：87

作者：

Ho, Ming-Chih ^{[1
,2
]}

Hasegawa, Kiyoshi ^{[3
,4
]}

Chen, Xiao-Ping ^{[5
]}

Nagano, Hiroaki ^{[6
]}

Lee, Young-Joo ^{[7
]}

Chau, Gar-Yang ^{[8
,9
]}

Zhou, Jian ^{[10
,11
]}

Wang, Chih-Chi ^{[12
]}

Choi, Young Rok ^{[13
]}

Poon, Ronnie Tung-Ping ^{[14
]}

Kokudo, Norihiro ^{[3
,4
]}

机构：

[1] Natl Taiwan Univ Hosp, Dept Surg, 7 Chung Shan South Rd, Taipei 100, Taiwan

[2] Natl Taiwan Univ, Coll Med, 7 Chung Shan South Rd, Taipei 100, Taiwan

[3] Univ Tokyo, Grad Sch Med, Hepatobiliary Pancreat Surg Div, Dept Surg, Tokyo, Japan

[4] Univ Tokyo, Grad Sch Med, Artificial Organ & Transplantat Div, Dept Surg, Tokyo, Japan

[5] Huazhong Univ Sci & Technol, Tongji Med Coll, Tongji Hosp, Dept Surg, Wuhan, Peoples R China

[6] Osaka Univ, Grad Sch Med, Dept Surg, Osaka, Japan

[7] Asan Med Ctr, Dept Surg, Seoul, South Korea

[8] Taipei Vet Gen Hosp, Dept Surg, Taipei, Taiwan

[9] Natl Yang Ming Univ, Sch Med, Taipei, Taiwan

[10] Fudan Univ, Zhongshan Hosp, Dept Liver Surg, Shanghai, Peoples R China

[11] Fudan Univ, Zhongshan Hosp, Liver Canc Inst, Shanghai, Peoples R China

[12] Chang Gung Mem Hosp, Kaohsiung Med Ctr, Dept Surg, Kaohsiung, Taiwan

[13] Seoul Natl Univ, Coll Med, Dept Surg, Seoul, South Korea

[14] Univ Hong Kong, Dept Surg, Hong Kong, Hong Kong, Peoples R China

来源：

LIVER CANCER | 2016年 / 5卷 / 04期

关键词：

Hepatocellular carcinoma; Outcome; Staging system; Surgery; VEIN TUMOR THROMBUS; MAJOR PORTAL-VEIN; LONG-TERM SURVIVAL; INFERIOR VENA-CAVA; HEPATIC RESECTION; SURGICAL RESECTION; PROGNOSTIC-FACTORS; 10; CM; TRANSARTERIAL CHEMOEMBOLIZATION; EXTRAHEPATIC METASTASIS;

D O I：

10.1159/000449336

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: The Barcelona Clinic Liver Cancer (BCLC) staging and treatment strategy does not recommended surgery for treating BCLC stage B and C hepatocellular carcinoma (HCC). However, numerous Asia-Pacific institutes still perform surgery for this patient group. This consensus report from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting aimed to share opinions and experiences pertaining to liver resection for intermediate and advanced HCCs and to provide evidence to issue recommendations for surgery in this patient group. Summary: Thirteen experts from five Asia-Pacific regions were invited to the meeting; 10 of them (Japan: 2, Taiwan: 3, South Korea: 2, Hong Kong: 1, and China: 2) voted for the final consensus. The discussion focused on evaluating the preoperative liver functional reserve and surgery for large tumors, multiple tumors, HCCs with vascular invasion, and HCCs with distant metastasis. The feasibility of future prospective randomized trials comparing surgery with transarterial chemoembolization for intermediate HCC and with sorafenib for advanced HCC was also discussed. The Child-Pugh score (9/10 experts) and indocyanine green retention rate at 15 min (8/10) were the most widely accepted methods for evaluating the preoperative liver functional reserve. All (10/10) experts agreed that portal hypertension, tumor size >5 cm, portal venous invasion, hepatic venous invasion, and extrahepatic metastasis are not absolute contraindications for the surgical resection of HCC. Furthermore, 9 of the 10 experts agreed that tumor resection may be performed for patients with >3 tumors. The limitations of surgery are associated with a poor liver functional reserve, incomplete tumor resection, and a high probability of recurrence. Key Messages: Surgery provides significant survival benefits for Asian-Pacific patients with intermediate and advanced HCCs, particularly when the liver functional reserve is favorable. However, prospective randomized controlled trials are difficult to conduct because of technical and ethical considerations. Copyright (C) 2016 S. Karger AG, Basel

引用

页码：245 / 256

页数：12

共 47 条

[1]

Andreou A, 2013, J GASTROINTEST SURG, V17, P77

[2] Impact of hepatectomy for huge solitary hepatocellular carcinoma [J].