Clinical Study Of Laparoscopic Anatomical Hepatectomy And Non-anatomical Hepatectomy In The Treatment Of Primary Liver Cancer

Background At present,the clinical effect of laparoscopic hepatectomy in the treatment of primary liver cancer has been widely accepted and approved.however,there are few studies on the clinical effects of laparoscopic anatomical hepat ectomy and non-anatomical hepatectomy on primary liver cancer,and the tumor size is more controversial on the clinical effect of laparoscopic anatomical hepatectomy（LAH）and laparoscopic non-anatomical hepatectomy（LNAH）.This study aims at primary liver cancer with tumor diameter < 10 cm.To explore the clinical effects of LAH and LNAH.Methods The clinical data of patients with primary liver cancer who underwent laparoscopic hepatectomy in Zhejiang people’s Hospital from January 2015 to August 2020 were analyzed retrospective ly.257 cases were collected and divided into LAH group and LNAH group.LAH group（n =104cases）and LNAH group（n = 153cases）.Subgroup analysis was performed according to whether the tumor diameter was less than 3cm,including 45 cases in LAH group and L NAH83 cases in tumor diameter ≤ 3cm subgroup,and 59 cases in LAH group and 70 cases in LNAH group in tumor diameter >3cm subgroup.The baseline characteristics,perioperative results,postoperative pathological data and recurrence,and prognostic factors of 257 patients undergoing HCC were compared between the two groups.Results The overall analysis showed that the baseline characteristics of the two groups were comparable;the operation time of the LAH group was significantly longer than that of the LNA H group（230.2min vs 165.6 min,P <0.01）;the overall recurrence rate of the LAH group was lower than that of the LNAH group（48.1% vs 67.3%,P= 0.076）.The 5-year disease-free survival rates of LAH group,LNAH group and LNAH group were 60.6% and 41.8%,respectively.Subgroup analysis showed that the median operation time in LAH group was significantly longer than that in LNAH group（199.0min vs152.5 min,P < 0.0l）.The overall recurrence rate in LAH group was lower than that in LNAH group（28.9% vs 33.7 min,P= 0.683）.The 5-year disease-free survival rates in LAH group and LNAH group were 62.5%,54.1% and 74.7%,respectively.When the tumor diameter > 3cm,the median operation time in the LAH group was significantly longer than that in the LNAH group（254.1min vs 181.1 min,P < 0.01）.The overall recurrence rate in the LAH group was significantly lower than that in the LNAH group（42.4% vs 57.1%,P= 0.036）.The 5-year disease-free survival rates of LAH group and LNAH group were 22.1%,10.6% and 56.4%,res pectively.Multivariate analysis showed that tumor margin ≤ 1cm（relative risk 1.531,95% confidence interval 1.056-2.439）,incomplete capsule（relative risk 2.503,95% confidence interval 1.288-3.878）and TNM stage III-IV（relative risk4.578,95% confide nce interval 1.174-17.852）were independent risk factors for postoperative disease-free survival.Tumor margin ≤ 1cm（relative risk1.876,95% confidence interval 1.248-3.101）,incomplete capsule（relative risk 2.432,95% confidence interval 1.288-3.878）and TNM stage（relative risk 2.312,95% confidence interval 1.758-3.415）are independent risk factors affecting overall postoperative survival.Conclusion Compared with laparoscopic non-anatomical hepatectomy,laparoscopic anatomical hepatectomy is safe and feasible,which can reduce the intrahepatic recurrence rat e and improve the disease-free survival time of small liver cancer,but has no significant effect on the overall survival rate.Tumor resection margin ≤ 1cm,incomplete capsule and TNM stage（III-IV stage）are independent risk factors for postoperative disease-free survival and overall survival.