The Comparison Of Risk And Curative Effect Between The Anatomical Resection And The Non-anatomical Resection Of Liver Cancer

Background and objective：In recent years the incidence of liver cancer in theworld increases year by year, more than626000/year, around the world, theincidence ranking the fifth in the malignant tumor, nearly600000deaths per year, isthe third of cancer-related death factor.In China, liver cancer incidence is high,accounts for about55%of the world’s patients.The liver cancer patients always withpoor prognosis, most of the patients with late and die within months.The cause ofliver cancer is not fully clear so far,most scholars believe that the liver cancer is theresult of the progress of liver cirrhosis and viral hepatitis, now thinking that thepathogenesis of liver cancer is related to many factors, such as hepatitis Bvirus(HBV), hepatitis C virus (HCV), alcohol and aflatoxin exposure are the mainpathogenic factors.Because of the difficulty of early detection and early treatment ofliver cancer,the liver cancer was seen as an incurable disease, but in recentyears,hepatitis B virus(HBV) and hepatitis C virus (HCV) were found to beimportant pathogenic factor. Using ultrasound screening and AFP, provide importantclues for prevention of liver cancer, and the progress of the liver surgery,theprognosis of liver cancer has been improved significantly.According to the patient,should be treated early,positively and comprehensively to improve the effect of thetreatment. Resection of liver cancer is the preferred and the most effective treatmentmethod, and can be combined with hepatic artery intubation chemotherapy embolismand radiofrequency ablation to eliminate the tumor, prolong patient survival andimprove patient life quality.Surgical resection is the preferred treatment for livercancer.But on a global scale，selection of operation is still inconclusive, also lack onthe basis of a large number of clinical prospective study，in China, the majority ofpatients was combined with hepatitis cirrhosis, so the non-anatomical liver resection is usually chosen, resection range from lesions edge1-2cm, to prevent postoperativeliver failure.But in recent years as the improvement of the preoperative evaluation ofliver function, operation and the preoperative management, some researchers thinkthat the anatomical liver resection of liver cancer is safe and feasible. Based on theabove reasons, this paper analysis the comparison of the risk and curative effectbetween the anatomical liver resection and the non-anatomical liver resection, so asto provide ideas for clinical work.Methods: We elected83liver cancer patients who had done anatomical liverresection and non-anatomical liver resection,51patients in the anatomical group and32patients in the non-anatomical group， having the correspondingoperation,anatomical liver resection or non anatomical resection of livercancer.Recording the intraoperative blood loss, duration of surgery, cutting edgesatisfactory patients，the patients with postoperative liver failure, bile leakage, ascitesand pleural effusion，and also recording the Alb,TBIL and CHE in the3days，5daysand7days after operation.Calculate3months,6months and1year recurrence rate,1year survival rate. Using the Logistic to analysis the factors affect the1year survivalrate,and do further stratified analysis with influential factors.According to the aboveresults to evaluate the risk and curative effect of the two groups.Results: A total of83patients,51patients in the anatomical group and32patients in the non-anatomical group.The intraoperative blood loss were550.0±62.0ml(anatomical group) and525.5±64.0(non-anatomical group), having nostatistical significance difference(p>0.05).The duration of surgery were4.0±0.5hand3.6±0.6h, the non-anatomical group is shorter than anatomical group,havingstatistical significance difference(p <0.05).Cut edge satisfaction is90.2%and59.4%,the anatomical group’s rate is higher than the non-anatomical group,havingstatistical significance difference(p <0.05).The total operative complication rate was19.6%(anatomical) and15.6%(non-anatomical),having no statistical significancedifference(p>0.05).The Alb,TBIL and CHE in the3days,5days and7days afteroperation and the ALT in the3days after operation have small differences between the two groups,having no statistical significance difference(p>0.05).But the ALT inthe5days and7days after operation of the anatomical group is much lower than thatof the non-anatomical group,having statistical significance difference(p <0.05).The3months recurrence rate is0.0%and3.1%,the6months recurrence rate is2.0%and9.4%,the1year recurrence rate is7.8%and25.0%,the anatomical group’s rate islower than that of non-anatomical,the3months recurrence rate and the6monthsrecurrence rate having no statistical significance difference(p>0.05) and the1yearrecurrence rate having statistical significance difference(p <0.05).1year survival rateis94.1%and78.1%,the anatomical group’s rate is much higher than that ofnon-anatomical, having statistical significance difference(p <0.05).The Logisticanalysis show that the gender, age, with and without postoperative complications andthe preoperative AFP value have no influence with the1year survival rate.And liverfunction Child-pugh A/B grade,with or without portal vein tumor thrombus and thetumor diameter have influence with the1year survival rate,so do further stratifiedanalysis of the liver function Child-pugh A/B,with or without portal vein tumorthrombus and the tumor diameter.For the Child-pugh A patients,the1year survivalrate of anatomical group is much higher than that of non-anatomical group,havingstatistical significance difference(p <0.05).For the Child-pugh B patients,the1yearsurvival rate of the two group having no statistical significance difference(p>0.05).For the patients with portal vein tumor thrombus,the1year survival rate ofanatomical group is much higher than that of non-anatomical group,having statisticalsignificance difference(p <0.05).For the patients without portal vein tumorthrombus,the difference of1year survival rate between the two group’s issmall,having no statistical significance difference(p>0.05).For the patients with thetumor less than5cm in diameter,the difference of1year survival rate between thetwo group’s is small,the1year survival rate of anatomical group is much higher thanthat of non-anatomical group,having statistical significance difference(p <0.05).Conclusions:For the liver cancer patients,there are no significant difference ofthe two groups between the intraoperative blood loss,operative complication and Alb,TBIL and CHE in the3days,5days and7days after operation and the ALT inthe3days after operation and the3months,6months recurrence rate.To comparedwith the non-anatomical group,the anatomical group has the longer duration ofsurgery,higher cutting edge satisfaction,lower ALT in5days and7dayspostoperatively,lower1year recurrence rate and higher1year survival rate,all ofthese having statistical significance difference(p <0.05).The Logistic analysis showthat liver function Child-pugh A/B grade,with or without portal vein tumor thrombusand the tumor diameter have influence with the1year survival rate.For theChild-pugh A patients,the1year survival rate of anatomical group is much higherthan that of non-anatomical group, for the patients with portal vein tumorthrombus,the1year survival rate of anatomical group is much higher than that ofnon-anatomical group,and for the patients with tumor less than5cm in diameter,the1year survival rate of anatomical group is much higher than that of non-anatomicalgroup,all of the above having statistical significance difference(p<0.05).Comprehensive the above considerations, in patients with poor liver functionis appropriate for non anatomical liver resection in to ensure that postoperative liverfunction is enough; In the case of liver function can allows anatomical liverresection，the1year survival rate can be improved, and the patients will haveobvious benefit.