Clinical Researches On The Surgical Treatments Of Patients With Hepatocellular Carcinoma And Hypersplenism Secondary To Cirrhosis

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Comparison of Surgical Treatments for Patients with Hepatocellular Carcinoma and Hypersplenism Secondary to Cirrhosis Objectives: There is no consensus on the treatments of patients with hepatocellular carcinoma and hypersplenism secondary to cirrhosis.The prognosis of patients underwent hepatectomy alone is poor.While liver tumors and hypersplenism can be treated by splenectomy combined with hepatectomy.The purpose of this study was to evaluate the short-term and long-term curative effects of splenectomy combined with hepatectomy by propensity score matching in patients with hepatocellular carcinoma and hypersplenism secondary to cirrhosis.Methods: From January 2011 to December 2016,the clinical data of patients with hepatocellular carcinoma and hypersplenism secondary to cirrhosis were collected retrospectively at the Department of Liver Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology.According to the operation,they are divided into the splenectomy combined with hepatectomy group(H-S group)and the hepatectomy group(H-O group).The propensity score matching was used to balance the differences between the baseline of the groups.The Kaplan-Meier method was used to calculate the survival curve of patients,and the differences between groups were compared by Log-rank test.The Cox risk ratio model was used to establish factors that affect the prognosis.Results: A total of 266 patients were included in this study.144 patients underwent splenectomy combined with hepatectomy were regarded as the H-S group;122 patients underwent hepatectomy were regarded as the H-O group.Before propensity score matching analysis,there were some differences between the baseline of the two groups.In the H-S group,patients had more ascites and varices and poorer liver function.Most patients in H-S group underwent open surgery and only a small portion of patients received anatomic resection.During the surgery,blood loss of patients in H-S group was more severe than that of patients in the H-O group,so more patients in the H-S group needed intraoperative blood transfusion.After the 1:1 propensity score matching analysis,a total of 138 patients were matched(69 cases in the H-S group and 69 in the H-O group).There were no differences in the baseline characteristics of the patients after matching.There was no statistical difference in the incidence of postoperative complications between the two groups(P=0.405).After propensity score matching analysis,the disease-free survival rates of the H-S group at 1,3,and 5 years after surgery were 73.0%,46.9% and 38.9% respectively.While the disease-free survival rates of the H-O group at 1,3,and 5 years were 58.7%,29.3% and 15.1%respectively.The disease-free survival rates of the H-S group was better than those of the HO group(P=0.009).The overall survival rates at 1,3,and 5 years in the H-S group were97.0%,87.8%,78.2%,respectively.While the overall survival rates of the H-O group at 1year,3 years,and 5 years were 92.6%,78.6% and 74.1% respectively.There were no statistical differences in the overall survival rates between the two groups(P=0.185).Univariate and multivariate analysis showed that hepatectomy without splenectomy(HR1.831,95%CI 1.322-2.535,P<0.001)is an independent risk factor for disease-free survival in patients with hepatocellular carcinoma and hypersplenism secondary to cirrhosis.Conclusion: Splenectomy combined with hepatectomy can improve the disease-free survival rates of patients with hepatocellular carcinoma and hypersplenism secondary to cirrhosis compared to hepatectomy.Part ? Effects of the Timing of Splenectomy on the Prognosis of Patients with Hepatocellular Carcinoma and Hypersplenism Secondary to CirrhosisObjectives: The pathological spleen with hyperfunction will change from anti-tumor effect to tumor-promoting effect.Hepatectomy combined with splenectomy can improve the disease-free survival rates of patients with hepatocellular carcinoma and hypersplenism secondary to cirrhosis.There are no relevant studies and reports about the effects of the timing of splenectomy on the prognosis of patients with hepatocellular carcinoma.The purpose of this study was to investigate the effects of splenectomy before hepatectomy on the treatment of hepatocellular carcinoma compared with synchronous splenectomy and hepatectomy.Methods: From January 2011 to December 2016,the clinical data of patients with hepatocellular carcinoma and hypersplenism secondary to cirrhosis were collected retrospectively at the Department of Liver Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology.All patients with hepatocellular carcinoma and hypersplenism who underwent splenectomy and hepatectomy were included in this study.The patients were divided into two groups: splenectomy before hepatectomy group(H-p S group,hepatectomy performed at least 1 month after splenectomy)and the synchronous splenectomy and hepatectomy group(H-s S group).The disease-free survival rates and overall survival rates between the two groups were compared.Results: A total of 144 patients who underwent splenectomy combined with hepatectomy were enrolled.Among them,splenectomy before hepatectomy was performed in 41 cases,and 103 cases underwent synchronous splenectomy and hepatectomy.The disease-free survival rates of the H-s S group at 1 year,3 years,and 5 years were 74.6%,48.4%,and 39.8%,respectively.While the disease-free survival rates of the H-p S group at 1 year,3 years,and 5 years were 80.1%,54.2 %,40.1%,respectively.There were no significant differences in disease-free survival rates between the two groups(P=0.603).The overall survival rates of the H-s S group were 94.9%,87.7%,and 79.7% at 1 year,3 years,and 5 years respectively.While the overall survival rates of the H-p S group were 96.8%,79.9% and 71.9% at 1 year,3 years,and 5 years,respectively.There were no significant differences in overall survival rates between the two groups(P=0.413).However,surgical blood loss,intraoperative blood transfusion,operation time,hospital stay,and postoperative complications in the H-p S group were fewer than those in the H-s S group.Conclusion: The different timing of splenectomy has no significant effects on disease-free survival or overall survival for patients underwent hepatectomy with hepatocellular carcinoma and hypersplenism.But the splenectomy before hepatectomy has less trauma and lower surgical risk compared with synchronous splenectomy and hepatectomy.Part ? Laparoscopic or Open Microwave Ablation and Hepatectomy Combined with Splenectomy for Patients with Hypersplenism Secondary to Cirrhosis and Hepatocellular Carcinoma within Milan CriteriaObjectives: Hepatectomy combined with splenectomy can improve the disease-free survival rates of patients with hypersplenism secondary to cirrhosis and hepatocellular carcinoma.However,the risk of liver resection is still high.Laparoscopic or open ablation combined with splenectomy can simultaneously treat liver tumors and hypersplenism.There are few reports about the curative effects of laparoscopic or open ablation combined with splenectomy.This study was conducted to explore the curative effects and safety of laparoscopic or open microwave ablation combined with splenectomy in the treatment of patients with hypersplenism secondary to cirrhosis and hepatocellular carcinoma within Milan criteria.Methods: Between January 2011 and December 2016,patients diagnosed with hepatocellular carcinoma within Milan criteria and hypersplenism secondary to cirrhosis in the Department of Liver Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology were retrospectively analyzed.These patients were divided into two groups: microwave ablation combined with splenectomy group(MWA-S group)and hepatectomy combined with splenectomy group(H-S group).Propensity score matching was adopted to balance the baseline.The prognosis of patients with hepatocellular carcinoma and hypersplenism secondary to cirrhosis and the safety of the operation were evaluated.Results: A total of 106 patients were enrolled in this study.24 patients received microwave ablation combined with splenectomy(MWA-S group)and 82 patients received hepatectomy combined with splenectomy(H-S group).Before matching,patients in the MWA-S group were older,with more tumors,more severe cirrhosis and higher ICG R15(P<0.05).A 1:1 propensity score match was used for the two sets of data,and a total of 32 cases(16 cases in the H-S group and 16 cases in the MWA-S group)were successfully matched.After matching,there were no significant differences in gender,age,ASA score,tumor size,tumor number,Child-Pugh class at admission,cirrhosis,varices,HBV-DNA copy number at admission,preoperative alpha-fetoprotein levels,preoperative platelet counts,and preoperative indocyanine green retention test after 15 min between the two groups(P>0.05).The median intraoperative blood loss in the MWA-S group was lower than that in the H-S group,but there were no significant differences(200.00[100.00-362.50]ml vs.300.00[175.00-525.00]ml,P=0.215).There were no differences in operative time,hospital stay and postoperative complications between H-S group and MWA-S group(P> 0.05).White blood cell and platelet counts in the MWA-S and H-S groups were significantly higher after surgery(P<0.001).Before propensity score matching,the disease-free survival rates in H-S group at 1,3,and 5 years after surgery were 73.6%,47.5% and 36.1%,and those in MWA-S group were 77.6%,25.9% and 25.9% respectively.There were no significant differences between the diseasefree survival rates of the two groups before matching(P=0.540).After matching,the diseasefree survival rates of patients in the H-S group at 1,3 and 5 years were 66.7%,46.7% and 46.7%,respectively.And those of patients in the MWA-S group were 86.7%,39.4% and 39.4%,respectively,with no statistical significance(P=0.675).Conclusion: For patients with hepatocellular carcinoma within Milan criteria and hypersplenism secondary to cirrhosis,laparoscopic or open microwave ablation combined with splenectomy can treat hepatocellular carcinoma and hypersplenism simultaneously with less trauma.Both hepatectomy and laparoscopic or open microwave ablation combined with splenectomy are safe and effective treatments for these patients.Part ? Analysis of Risk Factors and Construction of Risk Scoring Model for Early Postoperative Recurrence of Hepatocellular Carcinoma PatientsObjectives: Early recurrence is the main factor affecting the prognosis of patients with hepatocellular carcinoma.This study was conducted to investigate the risk factors for early recurrence in patients with hepatocellular carcinoma after hepatectomy and establish an evaluation model,so as to provide basis for predicting recurrence risk and improving prognosis.Methods: The clinical data of 225 patients with hepatocellular carcinoma treated in the Department of Liver Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology between 2011 and 2016 were retrospectively analyzed.The occurrence of early postoperative recurrence(recurrence within 2 years after hepatectomy)among the patients were analyzed.The independent risk factors for early recurrence were determined by Logistic regression model,the efficiencies of the variables in predicting the early recurrence were evaluated by receiver operating characteristic curve(ROC)and area under curve(AUC),and the risk scoring model for early recurrence was established by Cox regression equation.Results: Among the 225 patients,early recurrence occurred in 130 cases(57.8%).Tumor number,?-glutamyl transpeptidase(?-GT)and neutrophil-lymphocyte ratio(NLR)were independent risk factors for early recurrence in patients with hepatocellular carcinoma(P<0.05).The AUC of serum ?-GT,NLR and the combination of ?-GT and NLR for prediction of early recurrence were 0.676,0.591 and 0.704,respectively.After risk scoring model was created by incorporating tumor number,?-GT and NLR into the regression equation,a code of 1 was assigned to ?-GT >108 U/L,2 was assigned to NLR>2.11,and 3 was assigned to tumor number >1,otherwise 0 was assigned,according to the HR values.The possible score given by the risk scoring model ranged from 0 to 6.According to this model,the 1-,3-and 5-year disease-free survival rates were 76.9%,44.5% and 32.8% in patients in the low risk group(score <3),and were 33.4%,20.1%,and 6.69% in patients in the high risk group(score?3),and the difference had statistical significance(P<0.001).Conclusion: Tumor number,?-glutamyl transferase and neutrophil-lymphocyte ratio are independent risk factors for early postoperative recurrence in patients with hepatocellular carcinoma.The established prediction model can be used for stratifying the risk of early recurrence in patients with hepatocellular carcinoma,and thereby may help choose an appropriate treatment plan to improve the prognosis of the patients.