Comparison of clinical efficacy between re-hepatectomy and laparoscopic microwave ablation for recurrent small hepatocellular carcinoma

doi:10.3877/cma.j.issn.2095-3232.2022.03.009

Abstract

Abstract:

Objective

To compare the clinical efficacy between re-hepatectomy (RH) and laparoscopic microwave ablation (LMWA) in the treatment of recurrent small hepatocellular carcinoma (HCC).

Methods

Clinical data of 71 patients with recurrent small HCC treated in Hunan Provincial People's Hospital from January 2016 to January 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 44 patients were male and27 female, aged from 34 to 76 years, with a median age of 51 years. All patients were divided into the RH (n=40) and LMWA groups (n=31) according to different treatments. The operation time, length of postoperative hospital stay and hospitalization expense between two groups were compared by t test. Intraoperative blood loss was compared by Mann-Whitney U test. The incidence of postoperative complications was compared by Chi-square test. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

Results

Intraoperative blood loss in the LMWA group was 10(10) ml, significantly less than 200(100) mlin the RH group (Z=-7.278, P<0.05). In the LMWA group, the operation time, length of postoperative hospital stay and hospitalization expense were (37±11) min, (4.7±1.1) d and (1.6±0.4)×10⁴ Yuan, significantly less compared with (141±37) min, (9.6±1.9) d and (3.4±2.1)×10⁴ Yuan in the RH group(t=-235.125, -161.889, -23.359; P<0.05). In the LMWA group, the incidence of postoperative complications was 29%(9/31), significantly lower than 73%(29/40) in the RH group (χ²=1.309, P<0.05). The 1-, 2- and 3-year tumor-free survival rates in the RH and LMWA groups were 70.0%, 52.5%, 30.0%, and 67.7%, 48.4%, 29.0%, with no significant differences (χ²=0.042, P>0.05).

Conclusions

RH and LMWA yield similar clinical efficacy in the treatment of recurrent small HCC, whereas LMWA has significant advantages over RH in repeatability, expense, minimal invasiveness and safety, etc.

Key words: Carcinoma, hepatocellular, Laparoscopes, Microwave ablation, Hepatectomy, Efficacy

Jing Xie, Xianhai Mao, Jianhui Yang, Xiaohui Duan, Zhen'an Tian, Xiong Zhang, Xuzhao Gao. Comparison of clinical efficacy between re-hepatectomy and laparoscopic microwave ablation for recurrent small hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(03): 258-262.

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Figures/Tables 5

References 25

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组别	例数	年龄（岁，±s）	性别（例）		Child-Pugh分级（例）		肝炎（例）		肿瘤直径（cm，±s）
组别	例数	年龄（岁，±s）	男	女	A级	B级	有	无	肿瘤直径（cm，±s）
LMWA组	31	51±11	21	10	29	2	30	1	2.7±1.1
RH组	40	52±9	23	17	39	1	37	3	2.6±1.1
统计值		t=-0.070	χ²=0.777		χ²=0.674		χ²=0.6000		t=0.123
P值		0.792	0.378		0.412		0.439		0.727
组别	例数	AFP[μg/L，M（Q_R）]	TB[mmol/L，M（Q_R）]	ALT[U/L，M（Q_R）]	AST[U/L，M（Q_R）]	ALB（g/L，±s）
LMWA组	31	17（17）	19（17）	35（26）	35（27）	42±11
RH组	40	21（63）	18（9）	35（8）0	34（14）	48±4
统计值		Z=-1.652	Z=1.246	Z=0.296	Z=0.0930	t=-11.064
P值		0.099	0.213	0.767	0.926	0.001

组别	例数	年龄（岁，±s）	性别（例）		Child-Pugh分级（例）		肝炎（例）		肿瘤直径（cm，±s）
组别	例数	年龄（岁，±s）	男	女	A级	B级	有	无	肿瘤直径（cm，±s）
LMWA组	31	51±11	21	10	29	2	30	1	2.7±1.1
RH组	40	52±9	23	17	39	1	37	3	2.6±1.1
统计值		t=-0.070	χ²=0.777		χ²=0.674		χ²=0.6000		t=0.123
P值		0.792	0.378		0.412		0.439		0.727
组别	例数	AFP[μg/L，M（Q_R）]	TB[mmol/L，M（Q_R）]	ALT[U/L，M（Q_R）]	AST[U/L，M（Q_R）]	ALB（g/L，±s）
LMWA组	31	17（17）	19（17）	35（26）	35（27）	42±11
RH组	40	21（63）	18（9）	35（8）0	34（14）	48±4
统计值		Z=-1.652	Z=1.246	Z=0.296	Z=0.0930	t=-11.064
P值		0.099	0.213	0.767	0.926	0.001

组别	例数	术中出血量[ml，M(Q_R)]	手术时间（min，±s）	术后住院时间（d，±s）	住院费用（万元，±s）	TB[mmol/L，M(Q_R)]	ALT[U/L，M(Q_R)]	AST[U/L，M(Q_R)]	ALB（g/L，±s）
LMWA组	31	10（10）	37±11	4.7±1.1	1.6±0.4	21（14）	41（24）	38（16）	38.1±2.8
RH组	40	200（100）	141±37	9.6±1.9	3.4±2.1	32（34）	87（23）	87（42）	32.6±3.4
统计值		Z=-7.278	t=-235.125	t=-161.889	t=-23.359	Z=-3.194	Z=-5.577	Z=-5.322	t=52.300
P值		<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05

组别	例数	术中出血量[ml，M(Q_R)]	手术时间（min，±s）	术后住院时间（d，±s）	住院费用（万元，±s）	TB[mmol/L，M(Q_R)]	ALT[U/L，M(Q_R)]	AST[U/L，M(Q_R)]	ALB（g/L，±s）
LMWA组	31	10（10）	37±11	4.7±1.1	1.6±0.4	21（14）	41（24）	38（16）	38.1±2.8
RH组	40	200（100）	141±37	9.6±1.9	3.4±2.1	32（34）	87（23）	87（42）	32.6±3.4
统计值		Z=-7.278	t=-235.125	t=-161.889	t=-23.359	Z=-3.194	Z=-5.577	Z=-5.322	t=52.300
P值		<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05

组别	例数	肝衰竭	胆漏	胃肠道穿孔	腹腔出血	胸腔积液
LMWA组	31	0	2	0	1	6
RH组	40	1	5	2	4	17

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