| Objective: To explore the clinical application value of three dimensional reconstruction in precise hepatectomy and the value of combining albumin-bilirubin(ALBI)score with standardized future liver remnant(sFLR)predicting post hepatectomy liver failure(PHLF)and prognosis of patients with hepatocellular carcinoma.Method: The clinical datas of patients with hepatocellular carcinoma(HCC)who underwent curative hepatectomy in the Second and the Fifth Department of General Surgery,the First Hospital of Lanzhou University from January 2016 to June 2018 were retrospectively reviewed.The patients were divided into the reconstruction group and the non-reconstruction group according to whether three dimensional reconstruction was used for preoperative evaluation and surgical planning,whose intraoperative and postoperative conditions,postoperative complications and prognosis were analyzed and compared.In the reconstruction group,the risk factors of PHLF were analyzed by Logistic regression,receiver operating characteristic curve was used to analyze predictive value of ALBI score,sFLR and combining ALBI score with sFLR.The factors affecting postoperative prognosis of HCC patients were analyzed by Cox regression,Kaplan-Meier method is used to draw the survival curve and Log-rank test is used for survival analysis to compare the postoperative survival of HCC patients with different postoperative ALBI grades and sFLR.Results: A total of 149 patients were enrolled,including 72 patients in the reconstruction group and 77 patients in the non-reconstruction group.Intraoperative and postoperative conditions of the two groups were compared.Intraoperative blood loss,the rate of blood transfusion,extubation time,postoperative hospitalization time and total hospitalization cost in the reconstruction group were less than those in thenon-reconstruction group,and the difference was statistically significant(P<0.05).The operative time,the rate of hepatic portal occlusion,the probability of ICU and postoperative exhaust time in the reconstruction group were less than those in the non-reconstruction group,but the difference was not statistically significant.Incidences of ascites in the reconstruction group were less than that in the non-reconstruction group and the difference was statistically significant(P<0.05).Incidences of hemorrhage,hydrothorax or pulmonary infection,wound infection in the reconstruction group were less than that in the non-reconstruction group,but the difference was not statistically significant.There were significant differences in the occurrence of PHLF and Clavien-Dindo classification of postoperative complications between the two groups(P<0.05).The 1-year overall survival rates were 83.3% and the 1-year disease free survival rates were 68.6% in the reconstruction group.The1-year overall survival rates were 73.8% and the 1-year disease free survival rates were 59.1% in the non-reconstruction group.There was no statistically significant difference between the two groups in overall survival and disease free survival.72 patients in the reconstruction group are all Child Pugh-A grade,the incidences of PHLF was 27.78%(20/72),the incidences of PHLF in patients with AIBI-I,II grade were 12.96%(7/54)and 72.22%(13/18),with a statistically significant difference(P<0.05).The results of univariate analysis of PHLF showed that TBIL,ALB,PT,PLT,the diameters of portal vein,the range of hepatectomy,intraoperative blood loss,ALBI grade,sFLR were the factors affecting the occurrence of PHLF in HCC patients,the results of multivariable analysis showed that PLT(OR=0.03,P<0.05),ALBI grade(OR=11.758,P<0.05),sFLR(OR=0.835,P<0.05)were identified as independent predictors of PHLF.The area under the receiver operating characteristic curve for combining ALBI score with sFLR in predicting PHLF was 0.892,it was greater than that of the ALBI score(0.799)and sFLR(0.773).The results of univariate analysis of factors affecting overall survival after hepatectomy in HCC patients showed that virus replication,AFP,macrovascular invasion,microvascular invasion,the ratio of tumor to liver volume,tumor differentiation,sFLR were the factors affecting overall survival after hepatectomy in HCC patients,the results of multivariate analysis showed that macrovascular invasion(HR=7.803,P<0.05),microvascular invasion(HR=3.265,P<0.05)and sFLR(HR=0.179,P<0.05)were identified as independent prognostic factors affecting overall survival after hepatectomy in HCC patients.The results of univariate analysis of factors affecting disease free survival after hepatectomy in HCCpatients showed that AFP,macrovascular invasion,microvascular invasion,the number of tumors,tumor differentiation,sFLR,postoperative ALBI grade were the factors affecting disease free survival after hepatectomy in HCC patients,the results of multivariate analysis showed that: macrovascular invasion(HR=3.888,P<0.05),microvascular invasion(HR=2.825,P<0.05),postoperative ALBI grade(HR=2.806,P<0.05)and sFLR(HR=0.369,P<0.05)were identified as independent prognostic factors affecting disease free survival after hepatectomy in HCC patients.For the patients with AIBI-I grade and II grade,the 1-year overall survival rates were 85.4%and 76.9%,respectively,with a statistically insignificant difference,the 1-year disease free survival rates were 76.3% and 38.5%,respectively,with a statistically significant difference(P<0.05).For the patients with sFLR ≤70% and >70%,the 1-year overall survival rates were 61.8% and 95.7%,respectively,with a statistically significant difference(P<0.05),the 1-year disease free survival rates were 51.9% and 79.7%,respectively,with a statistically significant difference(P<0.05).Conclusion: Accurate preoperative evaluation and surgical planning by three dimensional reconstruction technique can reduce the occurrence of postoperative complications,accelerate postoperative recovery and reduce the economic burden of patients.ALBI score has the value in predicting PHLF and tumor recurrence of HCC patients,combining ALBI score with sFLR has better predictive value.On condition of R0 resection,preserving more liver volume can reduce the risk of PHLF and tumor recurrence,improve the long-term survival of HCC patients. |
