Analysis Of Surgical Diagnosis And Treatment Of 71 Cases Of Centrally Located Hepatocellular Carcinoma

Background and objective: As one of the most common malignant tumors,primary liver cancer is the fourth reason for tumor-related deaths all over the world.Primary liver cancer constitutes of hepatocellular carcinoma,cholangiocarcinoma and mixed cell carcinoma according to pathology.Among them,hepatocellular carcinoma accounts for the highest proportion of primary liver cancer,about 90%.Centrally located hepatocellular carcinoma usually refers to the tumor located in the IV,V,and VIII segments of Couinaud’s liver segments.Both mesohepatectomy and extended hemihepatectomy are used in the surgical resection of centrally located hepatocellular carcinoma,but the clinical results of the two surgical methods are not consistent in the literature.This study collects and compares profiles of patients during the perioperative period.This study investigates the feasibility and safety of mesohepatectomy and extended hemihepatectomy for centrally located hepatocellular carcinoma and provides a reference for clinical application.Methods: Retrospective analysis of 71 patients undergoing operations on centrally located hepatocellular carcinoma in our hospital from 2010-1-1 to 2018-1-1.According to the surgical method,they were divided into a mesohepatectomy group(MH group,n=30)and an extended hemihepatectomy group(EH group,n=41).The operation time,duration of vascular exclusion,intraoperative blood loss,postoperative liver function,postoperative hospital stay,postoperative complications,and survival rates in the first and third years after surgery were compared between the two groups.Results: The operation time(MHvs EH: 282.5±31.5vs236.5±37.2,P < 0.05),the duration of vascular exclusion of the mesohepatectomy group(MHvs EH:42.9±6.2vs34.8±6.9,P<0.05)was longer than those of extended hemihepatectomy group,but the peak postoperative bilirubin value of the mesohepatectomy group(MHvs EH:24.25±10.14vs35.15±19.87,P=0.008),the international normalized ratio(MHvs EH: 1.3±0.1vs1.5±0.2,P<0.05)were lower than those in the extended hemihepatectomy group,and the lowest postoperative albumin value in the extended hemihepatectomy group was lower than that in the mesohepatectomy group(MHvs.EH: 30.03±4.83vs27.15±3.62,P<0.05),the hospital stay in the mesohepatectomy group was shorter(MHvs.EH:10.1±2.9vs12.51±4.2,P < 0.05).There was no statistical difference between the mesohepatectomy group and the extended hemihepatectomy group in incidence of postoperative complications of bile leakage,bleeding,ascites and pleural effusion(P>0.05),but there were 3 cases of liver failure in the extended hemihepatectomy group.The survival rates of the mesohepatectomy group and the extended hemihepatectomy group were similar in the first and third years after surgery(P=0.799)Conclusion: The operation time and duration of vascular exclusion of extended hemihepatectomy were shorter.Compared with extended hemihepatectomy,liver function recovered faster and postoperative hospital stay was shorter after mesohepatectomy without significantly increasing the incidence of postoperative complications.There were no statistical difference in the 1-year and 3-year overall survival rate between mesohepatectomy and extended hemihepatectomy.Mesohepatectomy is safe and effective for centrally located hepatocellular carcinoma.