Clinical Analysis Of Laparoscopic Hepatectomy With Different Difficulty On Postoperative Prognosis And Early Recurrence Of Primary Liver Cancer

ObjectiveWe explore the effect of laparoscopic hepatectomy with different difficulty on the postoperative and early recurrence of primary liver cancer,guide clinical application and provide some enlightenment for improving the early recurrence of liver cancer.MethodsThe data of 228 cases of primary liver cancer undergoing laparoscopic hepatectomy were collected.Inclusion criteria:1.The patient was diagnosed as primary liver cancer before operation,2.According to the "Guidelines for the Diagnosis and Treatment of Primary Liver Cancer(2022)",all CNLC stages:patients who received laparoscopic surgery within stage Ⅰa,stage Ⅰb,stage Ⅱa,and stage Ⅱb.Exclusion criteria:1.Postoperative pathological diagnosis does not belong to primary liver cancer;2.According to the Kawaguchi laparoscopic hepatectomy scoring system,the operation involves multiple degrees of resection or non-anatomical laparoscopic hepatectomy;3.Patients undergoing reoperation;4.Patients converted to laparotomy during operation;5.Patients with severe abdominal adhesion during operation;6.There are extrahepatic operations(except cholecystectomy);6.Patients with severe underlying diseases that affect the prognosis(such as chronic obstructive pulmonary disease,diabetes patients with unstable preoperative blood glucose control,coronary heart disease patients);7.Patients with incomplete follow-up data.According to the Kawaguchi laparoscopic hepatectomy scoring system,the patients were divided into three groups:low,medium and high difficulty.For the exploration of early recurrence factors:take the first recurrence after surgery or follow-up for 2 years as the end event,the factors that affect the recurrence are first tested by Kaplan-Meier for proportional risk hypothesis,and those who meet the requirements are analyzed by log-rank for single factor analysis.For items with statistically significant differences in univariate analysis,COX multivariate regression model was included to further analyze their independent influencing factors on early postoperative recurrence.ResultsThe results of laparoscopic hepatectomy with different difficulty were as follows:maximum tumor diameter,operation time,incidence of bile leakage,incidence of incision bleeding,early postoperative recurrence rate,postoperative drainage tube extraction time,postoperative abdominal drainage volume,postoperative hospital stay,1/3/5 days after surgery(WBC,NEU,PLT,ProCT,ALT,AST,PT),and 3/5 days after surgery(CRP,TBIL,DBIL)and K on the first day after surgery were statistically different(P<0.05),and increased with the increase of difficulty coefficient.There were statistical differences in hemoglobin and albumin on 1/3/5 days after surgery(P<0.05),but they decreased with the increase of difficulty coefficient.To explore the factors of early recurrence of primary liver cancer:the results of single factor analysis showed that preoperative AFP,hepatitis virus infection,hepatitis B virus DNA quantification,the largest diameter of the tumor,the degree of histological differentiation of the tumor,tumor MVI grade,whether to carry out comprehensive treatment after surgery Laparoscopic hepatectomy with different degrees of difficulty was a risk factor affecting the tumor-free survival rate after laparoscopic hepatectomy for primary liver cancer(P;The results of multivariate analysis showed that comprehensive treatment was better than comprehensive treatment after operation(HR=0.482,95%CI:0.301-0.772,P=0.002).Postoperative pathological MVI grade:M2 grade compared with M0 grade(HR=2.622,95%CI:1.644-4.182,P<0.01);Compare M1 with M2(HR=0.293,95%CI:0.156-0.547,P<0.01).Grouping comparison of laparoscopic hepatectomy with different difficulty:comparison of high difficulty and low difficulty(HR=2.352,95%CI:1.193-4.693,P=0.014).Conclusions1.The difficulty classification method proposed by Kawaguchi et al.for laparoscopic hepatectomy is practical and feasible in clinic.The results of laparoscopic hepatectomy with different difficulty were as follows:maximum tumor diameter,operation time,incidence of bile leakage,incidence of incision bleeding,early postoperative recurrence rate,postoperative drainage tube extraction time,postoperative abdominal drainage volume,postoperative hospital stay,1/3/5 days after surgery(WBC,NEU,PLT,ProCT,ALT,AST,PT),and 3/5 days after surgery(CRP,TBIL,DBIL),K increased with the increase of difficulty coefficient on the first day after surgery;On the 1st,3rd,5th day after surgery,hemoglobin and albumin decreased with the increase of difficulty coefficient.2.Postoperative comprehensive treatment is an independent protective factor for the tumor-free survival rate after laparoscopic hepatectomy,while the postoperative pathological MVI grade is M2,and the difficulty grade of laparoscopic hepatectomy is high,which is an independent risk factor for the tumor-free survival rate after laparoscopic hepatectomy.