| Objective To evaluate the safety and feasibility of laparoscopic hepatectomy,and to analyze the role of laparoscopic hepatectomy in the treatment of hepatocellular carcinoma.Method A retrospective analysis of the medical records of 760 patients with hepatocellular carcinoma undergoing surgical resection from January 2012 to December 2017 in The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University.Among them,70 cases underwent laparoscopic liver resection and 690 cases underwent hepatectomy.For the comparability of the data,70 cases of hepatectomy with the same number of laparoscopic hepatectomy were selected from the 690 cases.They were divided into laparoscopic hepatectomy group(n=70 cases)and hepatectomy group(n=70 cases).The preoperative general data,operation time,intraoperative blood loss,intraoperative blood transfusion,postoperative complications,length of hospital stay,hospitalization costs,disease-free survival,and overall survival were compared between the two groups.According to surgical resection,70 cases of laparoscopic liver resection were divided into regular hepatectomy group(n=29 cases)and irregular hepatectomy group(n=41 cases).A stratified analysis of the two groups was performed to compare the operation time,intraoperative blood loss,intraoperative blood transfusion,postoperative complications,postoperative liver function changes,length of stay,and hospitalization costs,disease-free survival and overall survival.Result All operations were successfully completed.Laparoscopic surgery had no conversion.All operations had no intraoperative deaths.There was no significant difference in preoperative general data between laparoscopic hepatectomy group and hepatectomy group(P>0.05).The operation time of laparoscopic hepatectomy group was 162.9±58.2min,and the operation time of hepatectomy group was 142.8±51.5min.There was a difference between the two groups(P=0.03).The intraoperative blood loss in the laparoscopic hepatectomy group was 204.4±278.1 ml.The intraoperative blood loss in the hepatectomy group was 292.7±152.6 ml.There was a difference between the two groups(P=0.02).There was no significant difference in intraoperative blood transfusion(P>0.05).The length of stay in the laparoscopic hepatectomy group was 14.6±3.7 days.The length of stay in the hepatectomy group was 17.8±7.9 days.There was a difference between the two groups(P=0.003).The two groups had no statistical significance in the hospitalization costs and postoperative complications(P>0.05).In the laparoscopic hepatectomy group,the disease-free survival rates at 1,2,and 3 years were 85.7%,73.3% and 55.7%,respectively.In the hepatectomy group,the diseasefree survival rates at 1,2,and 3 years were 82.8%,68.6% and 54.3%,respectively.In the laparoscopic hepatectomy group,the overall survival rates at 1,2,and 3 years were 92.8%,77.4%,and 65.3%,respectively.In the hepatectomy group,the overall survival rates at 1,2,and 3 years were 91.4%,71.2%,and 64.7%,respectively.There was no significant difference between the two groups in disease-free survival and overall survival(P>0.05).In the stratified analysis of the regular hepatectomy group and the irregular hepatectomy group,the operation time was 189.66±57.84 min in the regular hepatectomy group and 144.02±51.05 min in the irregular hepatectomy group.There was a significant difference between the two groups(P=0.001).The intraoperative blood loss in the regular hepatectomy group was 143.79±125.1ml,and in the irregular hepatectomy group was 248.78±263.74 ml.There was a significant difference between the two groups(P=0.03).There was no significant difference in intraoperative blood transfusion between the two groups(P>0.05).And there was no significant difference in length of stay,hospitalization costs and postoperative complications between regular hepatectomy group and irregular hepatectomy group(P>0.05).The ALT on the first postoperative day was 108.19±24.43 U/L in the regular hepatectomy group and 142.83±61.84 U/L in the irregular hepatectomy group.There was a significant difference between the two groups(P=0.006).The ALT on the third postoperative day was 90.07±19.88 U/L in the regular hepatectomy group and 121.49±55.04 U/L in the irregular hepatectomy group.There was a significant difference between the two groups(P=0.005).The AST on the first postoperative day was 112.80±25.59 U/L in the regular hepatectomy group and 135.99±36.25 U/L in the irregular hepatectomy group.There was a significant difference between the two groups(P=0.003).The AST on the third postoperative day was 93.05±21.7 U/L in the regular hepatectomy group and 115.72±34.98 U/L in the irregular hepatectomy group.There was a significant difference between the two groups(P=0.001).There was no significant difference between TBIL and ALB(P>0.05).In the regular hepatectomy group,the disease-free survival rates at 1,2,and 3 years were 86.2%,70.7%,44.3%,respectively.In the irregular hepatectomy group,the disease-free survival rates at 1,2,and 3 years were 85.4%,66.9%,and 55.5%,respectively.In the regular hepatectomy group,the overall survival rates at 1,2,and 3 years were 93.1%,82.2%,and 66.1%,respectively.In the irregular hepatectomy group,the overall survival rates at 1,2,and 3 years were 92.7%,79.6%,and 68.2%,respectively.There was no significant difference between the two groups in diseasefree survival and overall survival(P>0.05).There was no significant difference between the two groups in disease-free survival and overall survival(P>0.05).Conclusion Laparoscopic hepatectomy has significant clinical effects in the treatment of liver cancer.It has the advantages of less trauma,less pain,rapid postoperative recovery,low incidence of postoperative complications,short hospital stay,and beautiful surgical incisions.Laparoscopic hepatectomy can be safely and effectively applied to the treatment of HCC.In laparoscopic liver resection,it is recommended to give priority to anatomical hepatectomy,because it can effectively control intraoperative blood loss,effectively reduce the ischemia and reperfusion injury of the established liver,reduce hepatic congestion,intestinal bacterial translocation,and intestinal mucosal injury,postoperative liver function damage. |
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