Comparison Of Clinical Efficacy Between Anatomical And Non-anatomical Hepatectomy For Primary Hepatocellular Carcinoma

Background: Hepatocellular carcinoma(HCC)is one of the most common malignant tumors,and its mortality ranks second in the mortality rate of common malignant tumors in China.Liver cancer is not sensitive to radiotherapy and chemotherapy.At present,surgical resection is still an effective means of treating HCC.The surgical procedures are mainly divided into anatomic resection(AR)and nonanatomic resection(NAR).However,due to the current lack of randomized controlled trial(RCT),the main studies are retrospective studies,so it is not clear which surgical approach can achieve better clinical outcomes.Objective: To compare the clinical outcomes of anatomical hepatectomy(AR)and non-anatomical liver resection(NAR),and to analyze factors that influence patient survival.Provide a basis for clinicians to guide patients’ treatment plans and prolong their survival.Methods: A retrospective analysis of 89 patients with HCC who underwent hepatectomy in the Second Affiliated Hospital of Dalian Medical University from March 2014 to January 2017,42 patients in the anatomical group and 47 patients in the non-anatomical group.The general data,intraoperative status,perioperative status and 2-year follow-up outcomes of the two groups were collected,and the clinical efficacy of the two groups was compared to analyze the factors affecting the postoperative tumor-free survival rate and overall survival rate(gender,age,cirrhosis,AFP,microvascular invasion,HBs Ag,diameter of liver function tumor,distance of cutting edge,surgical method,etc.).The statistical analysis of the data was performed by SPSS23.0 software.The measurement data were expressed by mean ± standard deviation(?X±S).Two independent samples t test were used,and the count data was analyzed by X2 test.The survival analysis was estimated by Kaplan-Meier method.Univariate and multivariate analyses were performed using the Kaplan-Meier method and the cox risk scale model,respectively.The test results were statistically significant at P < 0.05.Results: A total of 89 patients with liver cancer were enrolled,42 in the anatomical hepatectomy group and 47 in the non-anatomical hepatectomy group.There were no significant differences in gender,age,AFP,Child grade,tumor diameter,tumor location,preoperative ALT,AST,albumin,total bilirubin,postoperative complications,and hospital stay between the two groups(P>0.05).).The operation time of anatomical hepatectomy group(155.86±48.1)min was higher than that of non-anatomical hepatectomy group(115.36±34.6)min(P<0.05).The intraoperative blood loss was(268.33±139.2)ml and(344.89±160.6)ml,the anatomical hepatectomy group was significantly less than the non-anatomical group.On the third day after operation,the ALT,AST and ALB of the anatomical hepatectomy group were(208.39±189.9)U/L,(90.98±83.1)U/L and(35.56±3.7)g/L,respectively.In the non-anatomical hepatectomy group,ALT,AST and ALB were(410.44±301.2)U/L,(178.37±242.0)U/L and(33.83±4.3)g/L on the 3rd day after operation.After t-test,the difference between the two groups was significant(P<0.05),which was statistically significant.The 2-year recurrence rate was 28.5%(12/42)in the anatomical hepatectomy group,which was significantly better than that in the non-anatomical hepatectomy group(48.9%,23/47)(P<0.05).The 2-year mortality rate was 9.5%(4/42)and 12.7%(6/47),respectively,and no statistical difference was found(P>0.05).AFP(alpha-fetoprotein),microvascular invasion,and surgical procedures are independent risk factors for the disease-free survival of patients.AFP(alpha-fetoprotein)and ALT(alanine aminotransferase)are independent risk factors for the overall survival of patients.Conclusion:1.Anatomical hepatectomy requires more complicated non-anatomical liver resection,and it takes more time to operate.However,its operation is fine,intraoperative bleeding is less,and liver function damage can be reduced,so it is safer.2.Compared with non-anatomical hepatectomy,anatomical hepatectomy can reduce the early recurrence rate of HCC patients and improve the early stage tumor-free survival rate.3.Early recurrence of HCC is also closely related to AFP and microvascular invasion in peripheral blood.