Abstract
We retrospectively classified patients with hepatocellular carcinoma by the results of tests of 15-minute indocyanine green retention (ICGR15). Of the 201 patients with hepatocellular carcinoma admitted to our department in the past 6 years, 36 patients were assigned to group 1 (ICGR15 <10.0%), 81 patients to group 2 (ICGR15=10.1–20.0%), and 84 patients to group 3 (ICGR15≥20.1%). Of the total 201 patients, 72% underwent liver resection (78% of group 1 patients, 80% of group 2 patients, and 62% of group 3 patients).
We regarded the cirrhosis of the patients in group 3 as severe and studied their survival rate classified by the treatment used. Of these 84 patients, 52 patients were treated by liver resection, about half of whom were treated preoperatively by transcatheter arterial embolization (TAE). Another 9 patients were treated preoperatively by both TAE and portal vein embolization (PVE). At 2 years, and again at 3 years, the survival rate was significantly higher when TAE was used preoperatively than with resection alone. We think that the possibility of performing needed liver resection will be enlarged by preoperative PVE and that liver resection can be done more safely after use of PVE in some patients.
Résumé
Nous avons classé rétrospectivement des patients présentant un cancer hépatocellulaire selon les résultats d'un test de rétention pendant 15 minutes du vert indocyanique (RVIC15). Au cours des 6 dernières années, sur 201 patients admis dans notre département et présentant un cancer hepatocellulaire, 36 appartenaient au groupe 1 (RVIC15<10.0%), 81 au groupe 2 (RVIC=10.1–20.0%), et 84 au groupe 3 (RVIC15≥20.1%). Sur 201 patients, 72% ont subi une résection hépatique (78% dans le groupe 1, 80% dans le groupe 2, et 62% dans le groupe 3). Dans le groupe 3, la cirrhose était considérée comme grave. Nous avons ensuite étudié la survie selon le type de traitement. Parmi les 84 patients du groupe 3, 52 ont subi une résection hépatique. La moitié d'entre eux a subi en période préopératoire une embolisation artérielle par cathéter (EAC). Neuf patients ont eu une EAC et une embolisation de la veine porte (EVP). La survie à 2 et 3 ans était plus longue de façon significative lorsque les patients avaient eu une EAC avant l'opération par rapport à ceux qui n'avaient eu qu'une résection. Nous pensons que les indications de la résection hépatique peuvent être élargies grâce à la EAC préopératoire et que l'EAC augmente la sécurité de la chirurgie hépatique dans certains cas.
Resumen
Hemos clasificado retrospectivamente a los pacientes con carcinoma hepatocelular mediante los resultados de la prueba de retención a 15 minutes del verde indociamina (VIC15). De los 201 pacientes con carcinoma hepatocellular ingresados a nuestro departamento en los últimos 6 años, 36 fueron asignados al grupo 1 (VIC15<10.0%), 81 al grupo 2 (VIC15=10.1–20.0%), y 84 al grupo 3 (VIC15≥20.1%). Del total de los 201 pacientes, 72% fueron sometidos a resección hepática: 78% del grupo 1, 80% del grupo 2, y 62% del grupo 3.
Consideramos como severa la cirrosis de los pacientes en el grupo 3 y analizamos su tasa de supervivencia de acuerdo a la modalidad de tratamiento utilizado. De estos 84 pacientes, 52 fueron sometidos a resección hepática y en alrededor de la mitad se realizó embolización preoperatoria por catéter transarterial (ECTA). Otros 9 fueron tratados preoperatoriamente mediante ECTA y embolización por vía de la vena porta (EVP). A los 2 años, y también a los 3 años, la tasa de supervivencia fue significativamente mayor cuando se realizó ECTA preoperatoriamente que cuando se realizó solamente la resección. Creemos que la posibilidad de realizar la necesaria resección hepática puede ser ampliada mediante la EVP y que la resección puede ser lograda en forma más segura después de la EVP en algunos casos.
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Supported in part by a Grant-in-Aid for Cancer Research (59-6) from the Ministry of Health and Welfare.
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Fujio, N., Sakai, K., Kinoshita, H. et al. Results of treatment of patients with hepatocellular carcinoma with severe cirrhosis of the liver. World J. Surg. 13, 211–217 (1989). https://doi.org/10.1007/BF01658403
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DOI: https://doi.org/10.1007/BF01658403