Selection of patients with esophageal varices for liver resection of hepatocellular carcinoma
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- Midorikawa Yutaka
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
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- Takayama Tadatoshi
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
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- Higaki Tokio
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
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- Aramaki Osamu
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
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- Yoshida Nao
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
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- Teramoto Kenichi
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
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- Tsuji Shingo
- Genome Science Division, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan.
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<p>The presence of esophageal varices (EV) is a phenotype of portal hypertension, and the indications of liver resection for hepatocellular carcinoma (HCC) in patients with concomitant EV are conflicting. This retrospective study aimed to elucidate if there is justification for liver resection in patients with EV. The surgical outcomes were compared between the patients who underwent resection for HCC with EV (EV group) and those without EV (non-EV group) after propensity-score matching. More bleeding was prevalent (P < 0.001) and refractory ascites was more frequently observed (P = 0.031) in the EV group (n = 277) compared with the non-EV group (n = 277); however, the numbers of patients with morbidities (P = 0.740) and re-operation (P = 0.235) were not significantly different between the two groups. After a median follow-up period of 3.0 years, the median overall and recurrencefree survival periods of patients with EV were 4.8 years (95% confidence interval [CI], 4.1-5.9) and 1.7 years (1.5-2.0), respectively, and were significantly shorter than those of patients without EV (7.6 years [95% CI, 6.3.9.7], P < 0.001, and 2.2 years [1.9-2.5], P = 0.016). On multivariate analysis, the independent factors for overall survival in the EV group were indocyanine green clearance rate at 15 minutes, des-gamma carboxyprothrombin, and the presence of multiple tumors. Considering that liver resection for patients with EV can be safely performed, it should not be contraindicated. However, surgical outcomes of these patients were unsatisfactory, suggesting that candidates for resection for HCC should be carefully selected.</p>
収録刊行物
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- BioScience Trends
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BioScience Trends 14 (6), 436-442, 2020-12-31
特定非営利活動法人 バイオ＆ソーシャル・サイエンス推進国際研究交流会