Safety and efficacy of laparoscopic resection of giant liver cancer

doi:10.3877/cma.j.issn.2095-3232.2022.06.008

Abstract

Abstract:

Objective

To evaluate the safety and efficacy of laparoscopic resection of giant liver cancer.

Methods

Clinical data of 172 patients with giant liver cancer who underwent surgical resection in Nanfang Hospital of Southern Medical University and Zhujiang Hospital of Southern Medical University from January 2018 to December 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 152 patients were male and 20 female, aged (54±17) years on average. According to different surgical methods, all patients were divided into the laparoscopic resection group (n=78) and open resection group (n=94). Perioperative conditions and postoperative survival were compared between two groups. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

Results

In the laparoscopic resection group, intraoperative blood loss was 200(300) ml and intraoperative blood transfusion rate was 24%(19/78), significantly lower than 300(300) ml and 46%(43/94) in the open resection group (Z=-3.123, χ²=8.457; P<0.05). In the laparoscopic resection group, postoperative indwelling time was 6(4) d and the length of postoperative hospital stay was 8(3) d, significantly shorter than 8(5) d and 11(4) d in the open resection group (Z=-4.652, -6.110; P<0.05). In the laparoscopic resection group, the incidence of postoperative peritoneal effusion and Clavien-Dindo Ⅲ-Ⅳ severe complications were 1%(1/78) and 4%(3/78), significantly lower compared with 11%(10/94) and 15%(14/94) in the open resection group (χ²=6.234, 5.841; P<0.05). In the laparoscopic resection group, the R0 resection rate was 89%(69/78) and 85%(80/94) in the open resection group, and no significant difference was observed (χ²=0.414, P>0.05). In the laparoscopic resection group, the 1-year recurrence-free survival rate was 47%, and 52% in the open resection group, with no significant difference (χ²=0.001, P>0.05).

Conclusions

With sufficient technical experience and preoperative preparation, laparoscopic resection of giant liver cancer is safe and efficacious.

Key words: Liver neoplasms, Laparoscopes, Hepatectomy, Efficacy, Safety

Huakun Huang, Bin Yang, Qifan Zhang, Jingduo Deng, Zhi Chen, Yuan Cheng. Safety and efficacy of laparoscopic resection of giant liver cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(06): 569-573.

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References 28

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组别	例数	年龄(岁，±s)	性别(例)		BMI(±s)	肝炎(例)			肝硬化(例)		Child-Pugh分级(例)		CNLC分期(例)				BCLC分期(例)
组别	例数	年龄(岁，±s)	男	女	BMI(±s)	乙肝	丙肝	无	是	否	A	B	Ⅰb	Ⅱa	Ⅲa	Ⅲb	A	B	C
腔镜组	78	53±13	67	11	22±3	68	0	10	44	34	76	2	57	11	3	7	56	15	7
开腹组	94	54±12	85	9	23±3	85	1	8	60	34	89	5	56	16	5	17	55	21	18
统计值		t=-0.702	χ²=0.851		t=-0.722	χ²=1.637			χ²=0.982		χ²=0.829		χ²=4.149				χ²=4.399
P值		0.484	0.356		0.471	0.441			0.322		0.363		0.246				0.111

组别	例数	年龄(岁，±s)	性别(例)		BMI(±s)	肝炎(例)			肝硬化(例)		Child-Pugh分级(例)		CNLC分期(例)				BCLC分期(例)
组别	例数	年龄(岁，±s)	男	女	BMI(±s)	乙肝	丙肝	无	是	否	A	B	Ⅰb	Ⅱa	Ⅲa	Ⅲb	A	B	C
腔镜组	78	53±13	67	11	22±3	68	0	10	44	34	76	2	57	11	3	7	56	15	7
开腹组	94	54±12	85	9	23±3	85	1	8	60	34	89	5	56	16	5	17	55	21	18
统计值		t=-0.702	χ²=0.851		t=-0.722	χ²=1.637			χ²=0.982		χ²=0.829		χ²=4.149				χ²=4.399
P值		0.484	0.356		0.471	0.441			0.322		0.363		0.246				0.111

指标		腔镜组	开腹组	统计值	P值
手术时间[min，M(Q_R)]		286(155)	269(163)	Z=0.826	0.409
术中出血量[min，M(Q_R)]		200(300)	300(300)	Z=-3.123	0.002
术中输血(例)		19	43	χ²=8.457	0.004
术后转ICU(例)		3	8	χ²=1.549	0.213
术后引流管留置时间[d，M(Q_R)]		6(4)	8(5)	Z=-4.652	<0.001
术后住院时间[d，M(Q_R)]		8(3)	11(4)	Z=-6.110	<0.001
住院费用(万元，±s)		10±4	9±5	t=0.484	0.629
TB[U/L，M(Q_R)]		19(11)	20(14)	Z=-1.604	0.109
ALT[U/L，M(Q_R)]		262(326)	241(287)	Z=0.043	0.966
AST[U/L，M(Q_R)]		270(314)	288(252)	Z=-0.958	0.338
ALB(g/L，±s)		34(6)	33(6)	Z=1.512	0.131
术后并发症(例)
	胆漏	4	4	χ²=0.073	0.787
	出血	0	3	χ²=2.534	0.111
	切口延迟愈合	1	4	χ²=1.335	0.248
	胸腔积液	2	7	χ²=2.049	0.152
	腹腔积液	1	10	χ²=6.234	0.013
	肝功能不全	1	5	χ²=2.064	0.151
术后严重并发症(例)		3	14	χ²=5.841	0.016

指标		腔镜组	开腹组	统计值	P值
手术时间[min，M(Q_R)]		286(155)	269(163)	Z=0.826	0.409
术中出血量[min，M(Q_R)]		200(300)	300(300)	Z=-3.123	0.002
术中输血(例)		19	43	χ²=8.457	0.004
术后转ICU(例)		3	8	χ²=1.549	0.213
术后引流管留置时间[d，M(Q_R)]		6(4)	8(5)	Z=-4.652	<0.001
术后住院时间[d，M(Q_R)]		8(3)	11(4)	Z=-6.110	<0.001
住院费用(万元，±s)		10±4	9±5	t=0.484	0.629
TB[U/L，M(Q_R)]		19(11)	20(14)	Z=-1.604	0.109
ALT[U/L，M(Q_R)]		262(326)	241(287)	Z=0.043	0.966
AST[U/L，M(Q_R)]		270(314)	288(252)	Z=-0.958	0.338
ALB(g/L，±s)		34(6)	33(6)	Z=1.512	0.131
术后并发症(例)
	胆漏	4	4	χ²=0.073	0.787
	出血	0	3	χ²=2.534	0.111
	切口延迟愈合	1	4	χ²=1.335	0.248
	胸腔积液	2	7	χ²=2.049	0.152
	腹腔积液	1	10	χ²=6.234	0.013
	肝功能不全	1	5	χ²=2.064	0.151
术后严重并发症(例)		3	14	χ²=5.841	0.016

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