Association of remnant liver ischemia with early recurrence and poor survival after liver resection in patients with hepatocellular carcinoma
Menée en Corée du Sud à partir des résultats de tomographies numériques réalisées sur 328 patients atteints d'un carcinome hépatocellulaire traité par hépatectomie entre 2004 et 2013 (âge moyen : 58,2 ans ; 252 hommes et 76 femmes), cette étude met en évidence une association entre la présence d'une ischémie hépatique résiduelle après traitement et le risque de récidive précoce ou un pronostic défavorable
Importance : The remnant liver after hepatectomy may have inadequate blood supply, especially following nonanatomical resection or vascular damage.
Objective : To evaluate whether remnant liver ischemia (RLI) may have an adverse effect on long-term survival and morbidity after liver resection in patients with hepatocellular carcinoma.
Design, Setting, and Participants : This study was a retrospective analysis at Seoul National University Bundang Hospital. Remnant liver ischemia was graded on postoperative computed tomographic scans in 328 patients who underwent hepatectomy for hepatocellular carcinoma between January 1, 2004, and December 31, 2013.
Main Outcomes and Measures : Remnant liver ischemia was defined as reduced or absent contrast enhancement during the venous phase. Remnant liver ischemia was classified as minimal (none or marginal) or severe (partial, segmental, or necrotic).
Results : Among 328 patients (252 male and 76 female; age range, 26-83 years [mean age, 58.2 years]), radiologic signs of severe RLI were found in 98 patients (29.9%), of whom 63, 16, and 19 had partial, segmental, or necrotic RLI, respectively. These patients experienced more complications and longer hospital stay than patients with minimal RLI. Preoperative history of transarterial embolization (odds ratio [OR], 1.77; 95% CI, 1.02-3.03; P = .04), use of the Pringle maneuver (OR, 1.96; 95% CI, 1.08-3.58; P = .03), and longer operative time (OR, 1.003; 95% CI, 1.002-1.005; P < .001) were independent risk factors for severe RLI. Early recurrence rates within 6 (60.2% vs 9.6%) or 12 (79.6% vs 18.7%) months after hepatectomy were higher in patients with severe RLI than in patients without RLI (P < .001). Severe remnant liver ischemia was an independent risk factor for overall survival (OR, 6.98; 95% CI, 4.27-11.43; P < .001) and disease-free survival (OR, 5.15; 95% CI, 3.62-7.35; P < .001).
Conclusions and Relevance : Preventive management and technical refinements in hepatectomy are important to decrease the risk of RLI and to improve survival of patients with hepatocellular carcinoma.
JAMA Surgery , résumé, 2016