Safety and efficacy of five-step laparoscopic right hemihepatectomy via anterior approach for giant hepatocellular carcinoma

doi:10.3877/cma.j.issn.2095-3232.2022.01.008

Abstract

Abstract:

Objective

To evaluate the safety and efficacy of five-step laparoscopic right hemihepatectomy via the anterior approach (AA-RH) in the treatment of giant hepatocellular carcinoma (HCC).

Methods

Clinical data of 50 patients with giant HCC in the right lobe admitted to Zhujiang Hospital of Southern Medical University from December 2015 to September 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the laparoscopic group (n=25) and open group (n=25) according to different surgical methods. In the laparoscopic group, 20 patients were male and 5 female, aged (54±17) years on average. The maximum diameter of tumor was (11±6) cm. Five-step laparoscopic AA-RH was adopted. In the open group, 19 patients were male and 6 female, aged (55±12) years on average. The maximum diameter of tumor was (11±6) cm. Traditional open right hemihepatectomy was performed. Perioperative conditions were statistically compared between two groups. Intraoperative blood loss and postoperative liver function were compared by t test. The intraoperative blood transfusion rate and the incidence of postoperative complications was compared by Chi-square test.

Results

Operations in all the patients of two groups were completed successfully. No patient was converted to open surgery in the laparoscopic group. Intraoperative blood loss in the laparoscopic group was (285±85) ml, significantly less than (464±142) ml in the open group (t=-9.014, P<0.05). In the laparoscopic group, the intraoperative blood transfusion rate was 4%(1/25), significantly lower than 24%(6/25) in the open group (χ²=4.153, P<0.05). In the laparoscopic group, the ALT and AST levels at postoperative 1 d were (195±81) and (203±83) U/L, significantly lower compared with (288±114) and (295±106) U/L in the open group (t=-5.452, -6.229; P<0.05). The length of postoperative hospital stay in laparoscopic group was (10±4) d, significantly shorter than (12±5) d in the open group (t=-2.398, P<0.05). In the laparoscopic group, the incidence of postoperative complications was 8%(2/25), significantly lower than 32%(8/25) in the open group (χ²=4.500, P<0.05).

Conclusions

Five-step laparoscopic AA-RH is safe and feasible. Compared with the traditional open surgery, it can effectively reduce the intraoperative blood loss and blood transfusion rate, accelerate the postoperative recovery and lower the incidence of postoperative complications.

Key words: Carcinoma, hepatocellular, Hepatectomy, Laparoscopes, Anterior approach

Cheng Zhang, Chunming Wang, Kaihang Zhong, Yuan Cheng, Guolin He, Shunjun Fu, Lei Cai, Haiyan Liu, Mingxin Pan. Safety and efficacy of five-step laparoscopic right hemihepatectomy via anterior approach for giant hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(01): 32-38.

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URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2022.01.008

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References 30

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分组	例数	男性（例）	年龄（岁，±s）	肿瘤最大直径（cm，±s）	TB（μmol/L，±s）	ALB（g/L，±s）	INR（±s）	ALT（U/L，±s）	AST（U/L，±s）	Child-Pugh分级A级（例）	ICGR15（±s）
腔镜组	25	20	54±17	11.4±5.7	15.7±8.5	37±5	1.095±0.115	42±18	32±11	22	0.06±0.03
开腹组	25	19	55±12	11.1±5.9	16.1±8.7	36±4	1.100±0.120	40±17	30±9	21	0.07±0.03
统计值		χ²=0.117	t=-0.015	t=0.565	t=-1.175	t=0.663	t=-0.775	t=0.456	t=1.949	χ²=0.166	t=-0.613
P值		0.747	0.988	0.575	0.246	0.510	0.442	0.650	0.057	0.684	0.509

分组	例数	男性（例）	年龄（岁，±s）	肿瘤最大直径（cm，±s）	TB（μmol/L，±s）	ALB（g/L，±s）	INR（±s）	ALT（U/L，±s）	AST（U/L，±s）	Child-Pugh分级A级（例）	ICGR15（±s）
腔镜组	25	20	54±17	11.4±5.7	15.7±8.5	37±5	1.095±0.115	42±18	32±11	22	0.06±0.03
开腹组	25	19	55±12	11.1±5.9	16.1±8.7	36±4	1.100±0.120	40±17	30±9	21	0.07±0.03
统计值		χ²=0.117	t=-0.015	t=0.565	t=-1.175	t=0.663	t=-0.775	t=0.456	t=1.949	χ²=0.166	t=-0.613
P值		0.747	0.988	0.575	0.246	0.510	0.442	0.650	0.057	0.684	0.509

分组	例数	手术时间（min）	术中出血量（ml）	术后1 d ALT（U/L）	术后1 d AST（U/L）	住院时间（d）
腔镜组	25	191±46	285±85	195±81	203±83	10±4
开腹组	25	178±35	464±142	288±114	295±106	12±5
t值		1.613	-9.014	-5.452	-6.229	-2.398
P值		0.113	0.000	0.000	0.000	0.020

分组	例数	手术时间（min）	术中出血量（ml）	术后1 d ALT（U/L）	术后1 d AST（U/L）	住院时间（d）
腔镜组	25	191±46	285±85	195±81	203±83	10±4
开腹组	25	178±35	464±142	288±114	295±106	12±5
t值		1.613	-9.014	-5.452	-6.229	-2.398
P值		0.113	0.000	0.000	0.000	0.020

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