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Hepatocellular carcinoma:Surgical perspectives beyond the barcelona clinic liver cancer recommendations

World Journal of Gastroenterology 2014年第24期20卷 7525-7533页

作者： Alfredo Guglielmi rea Ruzzenente Simone Conci alessro valdegamberi Marco Vitali Francesca Bertuzzo Michela De Angelis Guido Mantovani Calogero Iacono Department of Surgery Division of General Surgery AUnit of Hepato-Pancreatico-Biliary surgeryUniversity of Verona Medical School37134 VeronaItaly

The barcelona clinic liver cancer(BCLC)staging system has been approved as guidance for hepatocellular carcinoma(HCC)treatment guidelines by the main Western clinical liver *** to the BCLC classification,only patients with a small single HCC nodule without signs of portal hypertension or hyperbilirubinemia should undergo liver *** contrast,patients with intermediate-advanced HCC should be scheduled for palliative therapies,even if the lesion is *** studies report good short-term and long-term outcomes in patients with intermediate-advanced HCC treated by liver ***,this classification has been criticised because it excludes many patients who could benefit from curative *** aim of this review was to evaluate the role of surgery beyond the BCLC *** liver resection can be performed in patients with portal hypertension and well-compensated liver function with a 5-year survival rate of 50%.Surgery also offers good long-term result in selected patients with multiple or large HCCs with a reported 5-year survival rate of over 50%and 40%,*** macrovascular invasion is associated with a poor prognosis,liver resection provides better long-term results than palliative therapies or best supportive ***,researchers have identified several genes whose altered expression influences the prognosis of patients with *** genes may be useful for classifying the biological behaviour of different tumours.A revision of the BCLC classification should be introduced to provide the best treatment strategy and to ensure the best prognosis in patients with HCC.

关键词： Hepatocellular carcinoma Liver resection Hepatecto

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Hepatocellular carcinoma in cirrhotic patients with portal hypertension:Is liver resection always contraindicated?

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World Journal of Gastroenterology 2011年第46期17卷 5083-5088页

作者： Andrea Ruzzenente Alessandro valdegamberi Tommaso Campagnaro Simone Conci Silvia Pachera Calogero Iacono Alfredo Guglielmi Department of Surgery Division of General Surgery"A"GB Rossi HospitalUniversity of Verona

AIM:To analyze the outcome of hepatocellular car-cinoma(HCC)resection in cirrhosis patients,related to presence of portal hypertension(PH)and extent of ***:A retrospective analysis of 135 patients with HCC on a background of cirrhosis was submitted to curative liver ***:PH was present in 44(32.5%)*** mortality and morbidity were 2.2% and 33.7%,*** survival time in patients with or without PH was 31.6 and 65.1 mo,respectively(P=0.047);in the subgroup with Child-Pugh class A cirrhosis,median survival was 65.1 mo and 60.5 mo,respectively(P=0.257).Survival for patients submitted to limited liver resection was not significantly different in presence or absence of ***,median survival for patients after resection of 2 or more segments with or without PH was 64.4 mo and 163.9 mo,respectively(P=0.035).CONCLUSION:PH is not an absolute contraindication to liver resection in Child-Pugh class A cirrhotic patients,but resection of 2 or more segments should not be recommended in patients with PH.

关键词：肝硬化肝切除患者肝癌禁忌高压平均存活时间 PH值

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