The Guiding Value Of ICGR15 In The Selection Of Surgical Methods For Small Hepatocellular Carcinoma

BackgroundHepatocellular carcinoma(HCC)is one of the most common malignant tumor in the world[1].In most cases,liver resection is the first choice for the treatment of liver cancer[2].However,there are still many restrictive factors,such as postoperative liver failure.Studies have shown that postoperative liver failure is the main cause of postoperative death in patients with liver cancer[3].New minimally invasive approach such as radiofrequency ablation(RFA)that has been used in the treatment of HCC.RFA has the characteristics of small trauma,quick recovery and coagulative necrosis of the lesion,it is a radical operation,especially suitable for small liver cancer[4-5].As the improvement of medical imaging technology and high-risk medical awareness,diagnosis rate of small HCC relatively rise.A number of studies have shown that,the long-term survival of patients with small hepatocellular carcinoma after radiofrequency ablation is similar to that of surgical resection[6-7].In addition,even RFA can be used to treat liver cancer with severe cirrhosis or poor liver function[8-11].If hepatic resection is performed in patients with poor liver function,the postoperative hepatic failure may be increased.Indocyanine green test is an important method to evaluate hepatic reserve function and has important application value[12-14].Indocyanine green test usually used indocyanine green 15 minutes retention rate as a quantitative index to evaluate hepatic reserve function[15].The guiding value of ICGR15 on the treatment of small hepatocellular carcinoma is rarely reported.Small hepatocellular carcinoma does not mean good liver function.If the liver reserve function is poor,there also have the possibility of postoperative liver failure.Therefore,to select a reasonable surgical method for the treatment of small hepatocellular carcinoma can effectively reduce the risk of liver failure.Combined with indocyanine green test,the purpose of this study is to compare the difference of liver failure rate after hepatectomy and radiofrequency ablation in the treatment of small hepatocellular carcinoma to guide the treatment of small hepatocellular carcinoma.ObjectObjective to investigate the value of ICGR15 in the selection of surgical approaches for small hepatocellular carcinoma.Methods1.Clinical data(including general clinical data and preoperative examination)of 267 patients with small hepatocellular carcinoma surgical treated in our hospital from January 2011 to December 2016 were collected.Among them,141 patients were underwent liver resection,there were 11 cases of liver failure.The other 126 patients were underwent percutaneous radiofrequency ablation(PRFA),there were 4 cases of liver failure.Compared the differences of general clinical data between liver resection patients and radiofrequency patients.2.Compared the difference of general clinical data and preoperative examination between patients with liver failure and patients with non hepatic failure after liver resection.Similarly,compared the difference of general clinical data and preoperative examination between patients with liver failure and patients with non hepatic failure after radiofrequency operation.3.According to the different indocyanine green retention rate at 15 minutes(ICGR15),hepatic resection patients and radiofrequency patients were divided into ICGR15<20% group,20% ≤ICGR15<40% group and ICGR15≥40% group.Compared the differences in the rate of hepatic failure after two operation in the corresponding group4.Correlation analysis of Child-Pugh(CP)classification and ICGR15 was performed.Results1.There was no statistically significant differences ongeneral clinical data and preoperative examination of patients with liver resection and radiofrequency(P>0.05).2.There were statistically significant differences in scores of ICGR15 and Child-Pugh of patients with hepatic failure and non hepatic failure after liver resection or radiofrequency(P<0.05).The scores of ICGR15 and Child-Pugh in patients with hepatic failure were higher than those in non hepatic failure patients,the other general clinical data and preoperative examination had no statistical significance(P>0.05).3.Postoperative hepatic failure rates of patients after liver resection in ICGR15<20%、20%≤ICGR15<40% and ICGR15≥40% group were 2.1%,16.7%,40%.The corresponding postoperative hepatic failure rates of RF patients were 0,2.1%,37.5%.When ICGR15<20% or ICGR15 ≥ 40%,two postoperative liver failure rate showed no significant difference(P>0.05).When 20% ≤ICGR15<40%,two postoperative liver failure rate was statistically significant(P<0.05).4.ICGR15 is associated with Child-Pugh classification,r=0.557,P<0.001 ConclusionsICGR15 has a guiding value for the operation mode of small hepatocellular carcinoma:When ICGR15<20%,two kinds of operation are relatively safe.When ICGR15≥40%,two postoperative liver failure risk is relatively large.It is proposed to elective surgery after correct the liver function.When 20%≤ICGR15<40%,liver failure risk after liver resection is greater than the risk of radiofrequency ablation.At this time,radiofrequency ablation is more secure.