Ｈｓ肝細胞癌に対する選択的肝阻血法を用いた系統的肝亜区域切除術による長期予後の改善

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  • Effectiveness of Anatomical Subsegmentectomy of the Liver Under Selective Portal Inflow Occlusion in Patients with Hepatocellular Carcinoma Limited to a Subsegment

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Purpose: To clarify whether differences in type of hepatic resection and hepatic inflow occlusion affect the outcome of patients with hepatocellular carcinoma (HCC) limited to one subsegment (Hs-HCC). Method: Thirty-seven Hs-HCC patients who had undergone curative hepatectomy were divided into two groups based on the type of resection: a group that underwent anatomical subsegmentectomy (HrS)(n=26) and a group that underwent non-anatomical limited resection (Hr0)(n=11). The patients in the HrS group were divided into two groups according to the type of hepatic inflow occlusion during hepatic resection: a total inflow occlusion (TPVO) group (n=16) and a selective inflow occlusion (SPVO) group (n=10), and clinicopathologic and tumor-related factors were compared between the groups. Moreover, factors affecting recurrence-free survival were examined by univariate followed by multivariate analyses. Postoperative survival and diseasefree survival were compared between the HrS group and the Hr0 group and between the TPVO group and the SPVO group. Results: The clinicopathologic background in the HrS and Hr0 groups was essentially similar except for age. Tumor size was the only tumor-related factor that was significantly greater in the HrS group than in the Hr0 group. There were no significant differences in either clinicopathologic or tumor-related factors between the TPVO group and the SPVO group. The postoperative survival and disease-free survival were better in the HrS group than in the Hr0 group, however, the difference did not reach the level of statistical significance. The postoperative survival and disease-free survival in the SPVO group were significantly better than those in the TPVO group. The PV invasion was significant factor for recurrence-free survival by the multivariate analysis (p=0.042). The type of PV occlusion was a significant factor for recurrence-free survival by univariate analysis (p<0.02) but did not reach the level of statistical significance by multivariate analysis. Conclusion: Anatomical subsegmentectomy under selective portal inflow occlusion is concluded to be a method of treatment that improves the outcome of the patients with Hs-HCC.

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