More Related Content Similar to Chinese Version of Surgery at the Borderline in Hepatocellular carcinoma (18) More from Eric Vibert, MD, PhD (10) Chinese Version of Surgery at the Borderline in Hepatocellular carcinoma2. 局限性…
作者 年 人数 90天死亡率 Underlying Parenchyma
Greco et al. 2001-2005 129 4.1% Abnormal Liver
Rosaye et al 2005-2011 2342 3.5% Abnormal Liver
Zhong et al 2000-2007 908 3.1% Abnormal Liver
Vigano et al 2000-2012 192 2.1% Abnormal Liver
Donadon et al 2004-2013 336 2% Abnormal Liver
Kim et al 2005-2010 454 0.7% Healthy Liver
Zhou et al 2006-2009 124 0.5% Healthy Liver
Faber et a; 2000-2010 148 0% Healthy Liver
5%肝硬化病人术后死亡率低于5%为“可接受”
4. 2005-2011 :
Cohort BRIDGE
8656 名病人
70% 非手术 (n=6134 )
30% 手术 (n=2342 )
70% Out BCLC Guidelines (n=1624)
30% In BCLC Guidelines (n=718 )
2% BCLC Guideline for Surg (n=123)
2015
6. 2005-2012 :
ITA.LI.CA Database
2090 病人
26% 手术治疗 (n=550 )
50% 局部治疗:TACE肝内导管动脉栓塞 或 放疗 (n=1046)
23% 姑息治疗 (n=494 )
手术 VS逐步治疗
生存率改善
BCLC 0 +62%
BCLC A +45+
BCLC AB +38%
BCLC B +49%
BCLC C -16%
2015
9. 死亡率X 3 : 6.1% (38/618) vs 2.8% (32/1274)
肝衰竭死亡率X 2 PO. : 17% vs 7%
10. 2008
1994-2004 : 455 病人其中130 人有门脉高压: 对术后生存
率无影响…
Child A / Sans HTP
56%
71%
Child A / Avec HTP
术后早期无影响,但长期存活率降
低
11. Makuuchi et al., Semin Surg Oncol 1993
腹水
无或控制 未控制
吲哚菁绿排泄试验
(ICG15)
限制性切除
摘除
无肝切除指征
2-3叶肝切除
左半肝切除
右半肝切除
局段性切除 限制性切除 摘除
正常l 1.1 – 1.5 mg/dL 1.6 – 1.9 mg/dL > 2.0 mg/dL
总胆红素水平
正常 10% - 19% 30% - 39% > 40%20% - 29%
残余肝脏质量
14. 2000-2010 : 231 病人,含 134 大部肝切除术,仅有3%行 PVE
In such condition, major impact of préoperative platelet rate < 150.000 / mL
22%
6%
9%的术后总体死亡率
2011
15. TACE PVE Major Hep.
病理生理血解释
1 门静脉栓塞导致动脉血流增加,增加HCC周围血流
2 肝门动脉内肿瘤减少门静脉栓塞的有效性
3 阻断术中肿瘤的转移
2003
17. Splenectomy and Hepatectomy (n=94)
Hepatectomy (n=110)
No Post-operative mortality and equivalent Morbidity… and Less recurrence
37%
23%
19. 术中门脉压的调节
MODHEP-1 : Phase I/II in Human
(Hop. Paul Brousse – Villejuif)
1. 脾动脉阻断
2. 门腔静脉分流 (8 mm Goretex)
Today… Tomorrow…
27. 2000 – 2011 : 62 病人– CHC > 10 cm (75%) 52%肝大部切除
15% of pts
in 201038 pts 有肝脏异常(32% F1/F2 / 29% F3/F4)
18% 术后死亡率
2013
32. 5年生存率10-15% Vp3/Vp4
Author Period
Portal Vein
Extension
N. Pts PO. Mort. Median
3-years
OS
5-years
OS
Matono et al. 1985-2005 Vp3/Vp4 29 3% 16.6 24% 17%
Ikai et al. 1990-2002 Vp3/Vp4 78 3.8% 8,8 21% 11%
Pawlick 1984-1999 Vp3 102 5.8% 11 17% 10%
Minigawa 1989-1998 Vp2/Vp3/Vp4 18 5.5% 18 42% 42%
Peng 2002-2007 Vp2 27 51% 37%
Vp3 68 17% 17%
Vp4 83 4% 4%
LeTreut 1988-2004 Vp2/Vp3/Vp4 26 11% 9 13%
Zhou Vp2/Vp3/Vp4 386 12%
Personnal Exp. 1992-201 Vp2/Vp3/Vp4 43 10% 7 19%
33. 我们的经验
1992 – 2014 : 43 pts
Vp1/Vp2 : 8 pts
Vp3/Vp4 : 35 pts
50%
30%
19%
35%
Atrophy of the side of the tumoral thrombus is the most important prognostic factor
34. 手术 vs TACE (HCC 及门脉栓塞)
Vp1 Vp2
Vp3 Vp4
Peng et al. Cancer 2012