高度肝機能障害を有する肝細胞癌症例に対する腹腔鏡下肝切除術の治療成績

Laparoscopic hepatic resection for hepatocellular carcinoma in patients with severe liver dysfunction

◆要旨：高度肝機能障害（ICG 15分値35％以上，肝障害度B）を有した肝細胞癌（肝癌）に対する腹腔鏡下肝切除術症例（n＝9，LH群）と開腹下肝切除術症例（n＝9，OH群）の治療成績を比較検討した．LH群で開腹移行例はなく，手術時間および出血量は2群間で差はなかった．術後合併症はLH群で1例（11％），OH群で5例に認めた（P＝0.13）．LH群はOH群よりも術後疼痛からの回復が早く（P＝0.03），術後在院日数が短かった（中央値11日vs 14日，P＝0.04）．進行度は2群間で差はなく，全生存率（P＝0.19）および無再発生存率（P＝0.95）に差はなかった．結論：高度肝機能障害を有する肝癌症例に対して腹腔鏡下肝切除術は有用な治療選択肢になると考えられる．

［Background］ The safety and outcomes of laparoscopic hepatic resection（LH） for hepatocellular carcinoma（HCC） with severe liver dysfunction remain controversial. ［Patients and Methods］ The clinical records of 18 patients with severe liver dysfunction（indocyanine green retention at 15 minutes rate of 35％ or more and liver damage B） who underwent hepatic resection were retrospectively reviewed. Of the 18 patients, 9 underwent LH（LH group） and the remaining 9 underwent conventional open hepatic resection（OH group）. We investigated the outcomes after surgery between the two groups.［Results］ No patients were converted to an open approach, and there were no differences in operation time, blood loss, and tumor stage between the two groups. Postoperative complications were noted in only one patient（11％） in the LH group and five patients（56％） in the OH group （P ＝ 0.13）. The length of recovery from postoperative pain（P ＝ 0.03） and duration of postoperative hospital stay（P ＝ 0.04） were shorter in the LH group than in the OH group. There were no significant differences in either the overall survival or disease-free survival rates between the two groups（P ＝ 0.19 and 0.95, respectively）. ［Conclusions］ Laparoscopic hepatic resection is safe and may be an effective treatment option for HCC patients with severe liver dysfunction.