| Background and Purpose:Effective treatment for HCC conforming to BCLC stage A4 and stage B is still insufficiency. The purpose of this study was to explore the safety, efficacy and long-term outcome of hepatic resection combined with intraoperative microwave ablation for HCC conforming to BCLC stage A4 and stage B.Materrials and Methods:Retrospectively analysis clinical data in Shanghai Eastern Hepatobiliary Surgery Hospital from March 2011 to June 2014, a total of 365 patients with HCC conforming to BCLC stage A4 and stage B underwent hepatic resection combined with intraoperative microwave ablation. Of these patients,113 cases were fulfilled the inclusion criteria and enrolled in this study. Datas of general informations, etiology, laboratory results, pre-operative imaging(Ultrasound, CT or MRI), hepatic resection, intraoperative microwave ablation, postoperative pathologic, postoperative complications, portal hypertension, prophylactic TACE, recurrence and continuous treatment, follow-up and so on were collected. After statistical analysis, overall survival rates (OS) and disease-free survival rates (DFS) were observed, long-term outcome and prognostic factors were evaluatedcomprehensively.Results:Of the 113 cases,97 males and 16 females (about 6:1) were included in the study. Mean age was 55.00±9.13 (40～85; median 53) years. A total of 113 patients with 295 tumors were treated by hepatic resection combined with intraoperative microwave ablation, the average number of treated tumors was 3.2(2～5) per-case. One hundred and fifty-three tumors underwent hepatic resection. The average number of resected tumors was 2.4(2～5) and the average diameter was 5.0 (1.5-13) cm; One hundred and thirty-nine tumors underwent intraoperative microwave ablation. The average number of ablated tumors was 1.3(1-4) and the average diameter was 1.8 (0.5～4.5) cm. The median follow-up time was 16.8 (1.6-38.5) months. All of the113 cases, technology and technical success rate was 99.1%. Local recurrence developed in 14.1±8.2 (1.8～37.5, median 10.8) months, local recurrence rates was 30.1%(32/113).1-,3-,5-months tumor recurrence rates was 0%(0/113),6.2%(7/113),13.3%(15/113), respectively. Except a patient died of liver failure a week after surgery, the remaining 18 patients developed tumor recurrence and died of tumor progression. The median survival time was 26.8 months, median OS was 31.4 months.1-,2-,3-years DFS and OS were 76.6%,58.7%,38.4% and 96.2%,67.8%, 56.7%, respectively. Thirteen patients experienced complications, the complication rate was 11.5%. The main complications included liver abscess complicated with hydrothorax and ascites(2 cases), pleural effusion(5 cases), bleeding(2 cases), renal insufficiency(1 case), liver abscess(1 case), The wound effusion(1 case). A patient died of liver failure a week after surgery, treatment-related mortality was 0.8%(1/113). Cox proportional hazards analysis showed that Child-Pugh grade B, number of tumor>3, unintact capsule and microvascular invasion were independent risk factors for OS, age> 60 years old, diameter of tumor>5cm, number of tumor> 3 were independent risk factors for DFS.Conclusions:Hepatic resection combined with intraoperative microwave ablation is a safe and effective modalities for patients with HCC conforming to BCLC stage A4 and stage B. Compared with traditional single hepatic resection and TACE, hepatic resection combined with intraoperative microwave ablation can provide better long-term outcome for patients with HCC conforming to BCLC stage A4 and stage B, and it also expanded the indications for hepatic resection. |
