Clinical effect of precise liver resection for large hepatocellular carcinoma

Abstract

Objective To evaluate the clinical effect of precise liver resection for large hepatocellular carcinoma (HCC) under the guidance of precision surgery theory. Methods The retrospective and descriptive study was conducted. The clinical data of 49 patients with HCC who were admitted to the First Affiliated Hospital of Sun Yat-Sen University between June 2014 and June 2015 were collected. The preoperative assessments of general condition and liver function were conducted, and the ratio of future liver volume/standard liver volume (FLV/SLV) was calculated. Patients underwent right hemihepatectomy, extended right hemihepatectomy or associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) based on preoperative comprehensive assessment. Observation indicators: (1) results of preoperative assessment; (2) operation situations: surgical procedures, time of hepatectomy, volumes of intraoperative blood loss and perioperative blood transfusion; time and volume of intraoperative blood loss in the first surgery, interval time between the first and second surgery, growth rate of liver volume up to the second surgery, time and volume of intraoperative blood loss in the second surgery; (3) postoperative situations: duration of postoperative hospital stay, postoperative complications (hepatic dysfunction, bile leakage, intra-abdominal infection, wound infection, pleural effusion, peritoneal effusion and subphrenic effusion); (4) follow-up situation. Follow-up using outpatient examination was performed to detect 1-year recurrence rate of patients up to June 2016. Measurement data with normal distribution were represented as ±s and measurement data with skewed distribution were represented as M (range). Results (1) Results of preoperative assessment: of 49 patients, grade A of Child-pugh classification was found in 46 patients and grade B in 3 patients. ICG R15 35% was detected in 46 patients, and ICG R15>15% or FLV/SLV<35% in 3 patients. (2) Operation situations: of 49 patients, 44, 2 and 3 patients underwent right hemihepatectomy, extended right hemihepatectomy and ALPPS, respectively. Operation time, volume of intraoperative blood loss, number of patients with perioperative blood transfusion and volume of perioperative blood transfusion were 230 minutes (range, 170-405 minutes), 400 mL (range, 100-5 000 mL), 19, 550 mL (range, 200-2 750 mL) in 44 patients undergoing right hemihepatectomy and 2 undergoing extended right hemihepatectomy, respectively. Three patients with ALPPS underwent successfully the first and second surgeries. Operation time, volume of intraoperative blood loss and interval time between the first and second surgeries were 80 minutes, 190 minutes, 180 minutes, 100 mL, 300 mL, 150 mL, 9 days, 11 days and 13 days in 3 patients with ALPPS, respectively. Growth rate of liver volume up to the second surgery, operation time and volume of intraoperative blood loss in the second surgery were 88.4%, 78.0%, 94.6%, 180 minutes, 215 minutes, 150 minutes, 100 mL, 100 mL, 400 mL in 3 patients with ALPPS, respectively. (3) Postoperative situations: duration of postoperative hospital stay of 44 patients with right hemihepatectomy and 2 with extended right hemihepatectomy was 17 days (range, 9-45 days). Eleven patients had postoperative complications. One patient with hepatic dysfunction was cured by liver protection therapy. One patient with bile leakage and abdominal infection was cured by symptomatic and antibiotic treatments. Two patients with wound infection received wound dressing and then wound was healed. Seven patients with pleural effusion, peritoneal effusion and subphrenic effusion received percutaneous catheter drainage, and no residual effusion was detected. Three patients with ALPPS didn't have postoperative complications. (4) Follow-up situation: all the 49 patients were followed up. The postoperative recurrence was detected in 12 patients within 1 year, with a recurrence rate of 24.5% (12/49). Conclusion Precise liver resection for large HCC under the guidance of precision surgery theory can effectively evaluate surgery risks and reduce the incidence of postoperative hepatic dysfunction. Key words: Carcinoma, hepatocellular; Precision hepatic surgery; Hepatectomy; Liver failure