中国普通外科杂志2026，Vol.35Issue(7)：1287-1298,12.DOI:10.7659/j.issn.1005-6947.260155
从"最大耐受切除"到"最大安全保留":肝细胞癌切除导向综合治疗的全周期功能管理
From maximum tolerable resection to maximum safe preservation:redefining functional management throughout the treatment continuum of hepatocellular carcinoma
摘要
Abstract
Hepatocellular carcinoma(HCC)commonly arises in the setting of chronic liver disease or cirrhosis.In resection-directed management,the focus has shifted from determining whether a tumor is technically resectable to achieving a balance among oncologic control,hepatic reserve,perioperative safety,and eligibility for future treatment after recurrence.Advances in immune checkpoint inhibitor-based antiangiogenic therapy,locoregional treatments,radiotherapy,ablation,and precision hepatectomy have enabled conversion resection or optimization of surgical conditions in selected patients with initially unresectable disease or unfavorable tumor characteristics.Nevertheless,clinically significant portal hypertension,impaired hepatic reserve,treatment-related liver injury,post-hepatectomy liver failure,and acute kidney injury remain major barriers to long-term benefit.Therefore,resection-directed management of HCC should evolve from the concept of"maximum tolerable resection"toward"maximum safe preservation".Comprehensive preoperative assessment should integrate hepatic functional reserve,future liver remnant volume,portal hypertension status,viral activity,and overall physiological fitness to define treatment intensity and safe resection boundaries.During treatment,dynamic reassessment is essential for identifying the optimal timing for conversion surgery or curative locoregional therapy.The selection of locoregional and surgical strategies should balance oncologic efficacy with preservation of liver function,while postoperative and long-term management should focus on functional recovery,recurrence surveillance,and maintenance of retreatment eligibility.Emerging technologies,including artificial intelligence,circulating tumor DNA-based minimal residual disease monitoring,and patient-derived organoid drug-sensitivity platforms,may further facilitate risk stratification and individualized decision-making.Ultimately,the goal of resection-directed comprehensive therapy for HCC extends beyond successful tumor removal to preserving liver function and sustaining long-term therapeutic opportunities throughout the disease course.关键词
癌,肝细胞/肝切除术/转化治疗/残肝功能保留/肝功能衰竭Key words
Carcinoma,Hepatocellular/Hepatectomy/Conversion Therapy/Remnant Liver Function Preservation/Liver Failure分类
医药卫生引用本文复制引用
楼振邦,程树群..从"最大耐受切除"到"最大安全保留":肝细胞癌切除导向综合治疗的全周期功能管理[J].中国普通外科杂志,2026,35(7):1287-1298,12.基金项目
国家重点研发计划基金资助项目(2022YFC2503700) （2022YFC2503700）
上海市重中之重-肝胆临床研究中心项目基金资助项目(2023ZZ02005) （2023ZZ02005）
上海市科技创新行动计划医学创新研究专项基金资助项目(22Y11908900). （22Y11908900）
