| Objective:Comparing the clinical efficacy of laparoscopic hepatectomy(LH)and open hepatectomy(OH)for hepatocellular carcinoma(HCC)in the caudate lobe to provide a reference for the treatment.Methods:We retrospectively analyzed the 73 patients with the clinical and pathological diagnosised HCC originating from the caudate lobe divided 17 cases in the LH group and 56 cases in the OH group from Department of Hepatobiliary Surgery of First Affiliated Hospital of Fujian Medical University and Mengchao Hepatobiliary Hospital of Fujian Medical University between April 1st,2003 and December 31 st,2018.The preoperative general condition,laboratory tests,pathological features,intraoperative condition,postoperative complications,recurrence rate and survival rate were compared between two groups.Results:There were no significant differences in general conditions,laboratory tests and clinicopathological features between the two groups(P>0.05).The operation time(146.12±64.07 min vs 186.6±60.64 min,P=0.030),intraoperative blood loss(150(50-300)ml vs 300(200-775)ml,P<0.001),intraoperative blood transfusion(0 cases vs 14 cases,P=0.030),postoperative hospital stay(7(5.5-9)d vs 13(11-17)d,P < 0.001)was statistically significant.There was no significant difference in the first hepatic portal occlusion time between them(P>0.05).There were 4 cases of postoperative complications in the LH group,the rate was 23.53%;the postoperative complications in the OH group were 13 cases,the rate was 23.21%.Postoperative complications were evaluated using the Clavien-Dindo classification.There were 3 cases of grade I~II and 1 case of grade III~IV in the LH group,13 cases of grade I~II and none in grade III~IV in OH group.There was no significant difference in the complications between the two groups(P>0.05).The postoperative pathology of the two groups confirmed that the surgical margin was clean and met the criteria of clinical radical resection.The median follow-up time was 24.88 months in the LH group and 36.69 months in the OH group.In the LH group,there were 6 cases of intrahepatic recurrence,the recurrence rate was 35.29%;2 cases were early recurrence,and the early recurrence rate was 11.76%.In the OH group,there were 27 cases of intrahepatic recurrence,2 cases of intrahepatic recurrence and extrahepatic metastasis,the recurrence rate was 51.79%;20 cases of early recurrence,the early recurrence rate was 35.71%.Among the patients with recurrence in the LH group,3 cases were single and 3 cases were multiple;in the OH group,20 cases were single and 9 cases were multiple.There was no significant difference in recurrence rate,recurrence type,recurrence time and number of recurrence between the two groups(P>0.05).The 1-,2-,and 3-year disease-free survival rates in the LH group were 70.59%,41.18% and 17.65%,respectively.The 1-,2-,and 3-year overall survival rates were 82.35%,47.06% and 29.41%,respectively.The 1-,2-,3-,and 5-year disease-free survival rates in the open group were 55.77%,44.23%,35.54%,and 15.38%,respectively.The 1-,2-,3-,and 5-year overall survival rates were 75.00%,55.77%,48.08%,and 21.15%,respectively.There was no significant difference in the disease-free survival rate and overall survival rate between the two groups(P>0.05).Conclusions:1.For patients with HCC in the caudate,LH was superior to OH in the reduction of operation time,intraoperative blood loss and postoperative hospital stay2.For patients with HCC in the caudate,LH was comparable with OH in the rate of postoperative complications and long-term prognosis... |
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