Effects Of Different Surgical Methods On Surgical Margins And Early Postoperative Recurrence Of Hepatocellular Carrcinoma

Objective:To analyze the impact of different surgical methods on the surgical margin and early postoperative recurrence of hepatocellular carcinoma.Methods:The clinical baseline characteristics,preoperative biochemical indexes,AFP,pathological examination results,intraoperative data,and recurrence data of 214 patients with hepatocellular carcinoma from the Second Affiliated Hospital of Nanchang University from January 2015 to December 2019 were retrospectively analyzed.Use t-tests or Mann-Whitney U tests for continuous variables and chi-square tests or Fisher’s exact tests for categorical variables.Univariate logistic regression was used to analyze all factors that may affect surgical margins,followed by multivariate logistic regression analysis.The effect of recurrence-free survival analysis on early relapse in both groups was estimated by using the Kaplan-Meier method.A p-value of< 0.05 is statistically significant.All statistical analyses were performed using IBM SPSS Statistics 25.Results:This study analyzed 214 patients,including 59 patients in the wide margin group and 155 patients in the narrow margin group.There were no significant differences in gender,BMI,tumor diameter,ASA grade,preoperative liver function indicators(ALT,AST,TBIL,ALB),and preoperative AFP between the two groups.The majority of patients were male,with a similar gender distribution between the two groups(76.3%vs.82.6%,P=0.295).The age of the wide margin group was 55.2 ± 11.4 years old,and the age of the narrow margin group was 59.2 ± 11.3 years old,with a statistically significant difference(P=0.022).The median tumor diameter in the wide margin group was 25.0 mm,while the median tumor diameter in the narrow margin group was 24.0mm.In terms of tumor location,there was a statistically significant difference between the two groups(P=0.015).In the narrow margin group,118 patients had tumors located in the right half of the liver.Univariate logistic regression analysis showed that age(P=0.023),tumor location(P=0.016),resection method(P=0.002),intraoperative assistance(P=0.007),and surgical time(P<0.001)were possible influencing factors(P<0.05).Multivariate logistic regression analysis showed that age(OR=1.054,95%CI=1.020～1.089,P=0.001),tumor location(OR=2.850,95% CI=1.271～6.389,P=0.011),resection method(OR=0.405,95% CI=0.179～0.913,P=0.029),intraoperative assistance(OR=0.346,95% CI=0.162～0.738,P=0.006),and surgical time(OR=0.992,95% CI=0.987～0.996,P<0.001)were the influencing factors for surgical margin(P<0.05).The 1-year,2-year,and 3-year recurrence free survival rates were 88.1%,81.4%,and 72.9% in the wide margin group,and 77.4%,65.8%,and 56.1%in the narrow margin group,respectively(P=0.0434).Conclusions:There was no significant difference between open and laparoscopic liver resection on the surgical margin.In terms of ensuring sufficient surgical margins,anatomic liver resection surgery is more adequate surgical margins than non-anatomical liver resection,and the use of techniques such as IOUS and ICG-FI during surgery can make up for the lack of laparoscopic surgery to accurately remove tumors.Surgical margins ≥ 1 cm improve early postoperative recurrence.