肝细胞癌解剖性与非解剖性肝切除术——一项国际多中心队列的短期和长期结果的国际多中心倾向评分匹配分析

IF 3.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2026-09-01 Epub Date: 2026-05-26 DOI:10.1016/j.hpb.2026.05.002

Soufyan El Adel, Derar Jaradat, Tijs J. Hoogteijling, Ye-Xin Koh, Andrea Benedetti Cacciaguerra, Simone Conci, Davit Aghayan, Margarida Casellas, Paolo Magistri, Daniel Osei-Bordom, Nadia Rusolillo, Celine de Meyere, Gabriel Zozaya, Denis Fisenko, Francesco Ardito, Victor Lopez-Lopez, Jawad Ahmad, Steven White, Moritz Schmelzle, Tom Gallagher, Mohammad Abu Hilal

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引用次数: 0

摘要

背景：肝细胞癌（HCC）的最佳手术技术仍然存在争议，特别是在比较解剖切除（AR）和非解剖切除（NAR）时，关于围手术期发病率和长期肿瘤预后之间的平衡。方法：这项国际、回顾性、多中心研究纳入了接受单发≤5厘米HCC切除术的患者。排除了接受大肝切除术（≥3节段）、两期肝切除术、门静脉栓塞或非治愈性手术的患者。倾向评分匹配（PSM）后，分析围手术期结局、无病生存期（DFS）和总生存期（OS），并根据手术入路和肿瘤大小进行亚组分析。结果：经倾向评分匹配后，每组纳入442例患者。NAR与更有利的围手术期预后相关，包括更短的手术时间、更少的出血量和更低的严重发病率。各组间DFS无差异。在总体匹配队列中，AR与肿瘤较大（≥3.6 cm）患者（81.3% vs. 61.3%; p = 0.022）和微创肝切除术患者（74.5% vs. 63.2%; p = 0.001）的OS改善相关（5年OS: 77.2% vs. 67.2%; p = 0.041）。肿瘤较小（≤3.5 cm）患者的OS无显著差异。结论：在选定的分析中，NAR与更好的围手术期预后相关，而AR与改善的OS相关。由于各组之间的DFS没有差异，并且亚组的发现是探索性的，因此这些结果应谨慎解释。总的来说，研究结果支持个体化的、针对肿瘤的手术方法。

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Anatomical versus non-anatomical liver resection for hepatocellular carcinoma – an international multicenter propensity score-matched analysis of short- and long-term outcomes in an international multicenter cohort

Background

The optimal surgical technique for hepatocellular carcinoma (HCC) remains debated, particularly regarding the balance between perioperative morbidity and long-term oncological outcomes when comparing anatomical resection (AR) with non-anatomical resection (NAR).

Methods

This international, retrospective multicenter study included patients undergoing resection for solitary HCC ≤5 cm. Patients undergoing major hepatectomy (≥3 segments), two-stage hepatectomy, portal vein embolization, or non-curative procedures were excluded. After propensity score matching (PSM), perioperative outcomes, disease-free survival (DFS), and overall survival (OS) were analyzed, with subgroup analyses by surgical approach and tumour size.

Results

After propensity score matching, 442 patients were included in each group. NAR was associated with more favourable perioperative outcomes, including shorter operative time, lower blood loss, and lower rates of severe morbidity. DFS did not differ between groups. AR was associated with improved OS in the overall matched cohort (5-year OS: 77.2% vs. 67.2%; p = 0.041), in patients with larger tumours (≥3.6 cm; 81.3% vs. 61.3%; p = 0.022), and in those undergoing minimally invasive liver resection (74.5% vs. 63.2%; p = 0.001). No significant OS difference was observed in patients with smaller tumours (≤3.5 cm).

Conclusion

NAR was associated with better perioperative outcomes, whereas AR was associated with improved OS in selected analyses. As DFS did not differ between groups and subgroup findings were exploratory, these results should be interpreted cautiously. Overall, the findings support an individualized, tumour-tailored surgical approach.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).