Effect Of Preoperative Antiviral Therapy On Liver Function Recovery, Complications And Short-term Prognosis After Resection Of Large Hepatocellular Carcinoma

Objective:To study the effect of preoperative antiviral therapy on postoperative liver function recovery,complications and short-term prognosis in patients with hepatitis B viral related large hepatocellular carcinoma complicated with high load of hepatitis B virus replication.Methods:A retrospective analysis was made on the surgical resection of hepatitis B viral related large hepatocellular carcinoma in the Department of Hepatobiliary surgery of the first affiliated Hospital of Guangxi Medical University from July 2017 to December 2019.143 patients were selected according to the inclusion and exclusion criteria.All patients with HBV-DNA≥10~4IU/ml were divided into antiviral group after antiviral therapy(HBV-DNA<10~4IU/ml),HBV-DNA<5×10~2IU/ml as the HBV-DNA negative group(n=44),5×10~2IU/ml≤HBV-DNA<10~4IU/ml group as the HBV-DNA low load group(n=46),and 53 patients without antiviral therapy as the non-antiviral group(n=53).The age,sex,liver cirrhosis,Ishak score,Child-Pugh grade,ASA grade,tumor diameter,clinical stage,ICG-R15,SRLVR,liver function index before and after operation,virological index,operation related parameters,incidence of postoperative complications,disease-free survival and overall survival were calculated.The above three groups of data were compared and analyzed by one-way ANOVA,nonparametric test,chi-square test,Kaplan-Meier and other statistical methods.Results:All the 143 patients were successfully treated by hepatectomy.The ALT in the HBV-DNA negative group and low load group was lower than that in the non-antiviral group on the 1st,3rd and 7th day after operation(P<0.05),but the HBV-DNA negative group and low load group on the postoperative day 1st,3rd and 7th day had no difference(P>0.05).The HBV reactivation rate in the non-antiviral group was higher than the HBV-DNA negative group and low load group(18.9%vs.4.5%,P<0.05;18.9%vs.4.3%,P<0.05),but the HBV-DNA negative group and low load group had no difference(P>0.05).The incidence of postoperative complications in HBV-DNA negative group and low load group was lower than non-antiviral group(40.9%vs.64.2%,P<0.05;43.5%vs.64.2%,P<0.05),but HBV-DNA negative group and low load group had no difference(P>0.05).The incidence of gradeⅡcomplications in the HBV-DNA negative group and low load group was lower than that in the non-antivirus group(18.2%vs.43.4%,P<0.05;17.4%vs.43.4%,P<0.05),but HBV-DNA negative group and low load group had no difference(P>0.05).There was no significant difference in severe complications(gradeⅢ-Ⅳ)among the three groups(P>0.05).In terms of individual complications,the incidence of ascites in the non-antiviral group was higher than HBV-DNA negative group and low load group(30.2%vs.13.0%,P<0.05;30.2%vs.11.4%,P<0.05).The incidence of liver insufficiency in the non-antiviral group was higher than that in the HBV-DNA negative group and low load group(15.1%vs.2.3%,P<0.05;15.1%vs.2.2%,P<0.05).There was no significant difference in the incidence of bile leakage,abdominal bleeding,pleural effusion,pulmonary infection,poor incision healing and other complications among the three groups(P>0.05).There were no significant differences in 1st,2nd and 3rd year cumulative tumor-free survival rate and cumulative survival rate among the three groups(P>0.05).Conclusion:Preoperative antiviral therapy can reduce the load of HBV-DNA,accelerate the recovery of postoperative liver function in patients with HBV-HCC,and reduce the incidence of postoperative complications.For patients with high HBV-DNA load,preoperative antiviral therapy to reduce HBV-DNA to below10~4IU/ml can lead to surgery as soon as possible,the recovery of postoperative liver function,complications and short-term prognosis compared with reduction to negative had no difference.