切缘宽度对原发性肝癌合并微血管侵犯患者并发症及预后的影响

目的探讨解剖性肝切除术不同切缘宽度对原发性肝癌合并微血管侵犯（MVI）患者术后并发症及预后的影响。 方法回顾性选取2016年10月至2018年12月于快速康复外科下行解剖性肝切除术的96例原发性肝癌合并MVI患者病例资料。根据手术切缘宽度分组为宽切缘组（切缘≥10 mm，n=39例）和窄切缘组（切缘<10 mm，n=57例）。观察两组患者术后并发症发生率及并发症分级；Kaplan-Meier生存曲线分析术后无复发生存（RFS）和总生存（OS）情况；COX回归模型分析不同切缘宽度对原发性肝癌合并MVI患者预后生存的影响。 结果宽切缘组患者术后并发症发生率为25.6%，窄切缘组患者并发症发生率为29.8%，两组并发症发生率及并发症Clavien-Dindo分级比较，差异均无统计学意义（P>0.05）。宽切缘组患者术后5年累积RFS为33.3%，累积OS为41.0%；窄切缘组患者术后5年累积RFS为24.6%，累积OS为36.8%。宽切缘组累积RFS高于窄切缘组（Log-Rank χ²=4.029，P=0.045），两组累积OS差异无统计学意义（Log-Rank χ²=0.837，P=0.402）。肿瘤直径、临床分期Ⅲ-Ⅳ期、肿瘤数目、淋巴结转移、包膜完整性及切缘<10 mm是影响患者术后无复发生存的独立危险因素（P<0.05）；肿瘤直径>5 cm、肿瘤多发灶、淋巴结转移是影响患者总生存的独立危险因素（P<0.05），术后辅助治疗是保护因素。 结论快速康复外科下解剖性肝切除术中宽切缘对原发性肝癌合并MVI患者术后并发症的发生没有影响，增加切缘宽度能够提高患者术后无复发生存率，但不改善总生存率。

Effect of margin width on complications and prognosis in patients with primary hepatocellular carcinoma complicated with microvascular invasion

ObjectiveTo investigate the effect of different margin widths in anatomical hepatectomy on postoperative complications and prognosis in patients with primary liver cancer complicated with microvascular invasion（MVI）. MethodsA total of 96 patients with hepatocellular carcinoma complicated with MVI who underwent anatomic hepatectomy in the Department of Rapid Recovery Surgery from October 2016 to December 2018 were retrospectively selected. According to the width of surgical margins，the patients were divided into wide margin group（margin ≥10 mm，n=39）and narrow margin group（margin < 10 mm，n=57）. The incidence and grade of postoperative complications were observed. Kaplan-Meier survival curves were used to analyze recurrence-free survival（RFS）and overall survival（OS）. COX regression model was used to analyze the effect of different margin widths on the prognosis and survival of patients with primary liver cancer complicated with MVI. ResultsThe incidence of postoperative complications in the wide margin group was 25.6%，and that in the narrow margin group was 29.8%. There was no significant difference in the incidence of complications and Clavien-Dindo classification between the two groups（P>0.05）. The 5-year cumulative RFS and OS of patients in the wide margin group were 33.3% and 41.0% respectively. The 5-year cumulative RFS and OS of the narrow margin group were 24.6% and 36.8%，respectively. The cumulative RFS of the wide margin group was higher than that of the narrow margin group（Log-Rank χ²=4.029，P=0.045），and there was no significant difference in the cumulative OS between the two groups（Log-Rank χ²=0.837，P=0.402）. Tumor diameter，clinical stage Ⅲ-Ⅳ，tumor number，lymph node metastasis，capsule integrity and resection margin < 10 mm were independent risk factors for recurrence-free survival（P<0.05）. Tumor diameter > 5 cm，multiple tumor foci and lymph node metastasis were independent risk factors for overall survival（P<0.05），and postoperative adjuvant therapy was a protective factor. ConclusionWide margin in anatomic hepatectomy under enhanced recovery after surgery has no effect on the occurrence of postoperative complications in patients with primary liver cancer complicated with MVI. Increasing the margin width can improve the postoperative recurrence-free survival rate of patients，but does not improve the overall survival rate.