Clinical Study And Efficacy Analysis Of Laparoscopic Microwave Ablation In Hepatocellular Carcinoma Patients

BACKGROUNDHepatocellular carcinoma(HCC)is the fifth most common malignancy in the world.Due to its high malignancy and high recurrence rate,hepatocellular carcinoma patients have a poor prognosis.In the guidelines for the treatment of hepatocellular carcinoma,there are various treatments options.With the development of non-surgical treatment,the prognosis of hepatocellular carcinoma has improved in recent years.Microwave ablation(MWA)is an effective local ablation technique for the treatment of primary hepatocellular carcinoma,which has obvious advantages over other ablation methods.MWA has three main ways: laparoscopic microwave ablation(LMWA),percutaneous microwave ablation(PMWA)and laparotomic microwave ablation.In the past,because of the special location or mass adjacent to the other abdominal organs,the conventional ablation method was difficult to achieve satisfactory ablation rate,or is prone to serious complications such as burns,peripheral organs and so on.With the development of laparoscopic technology,LMWA has gradually highlighted its advantages.In addition to the advantages of small trauma,LMWA can also treat a liver mass at a particular site,especially a mass near the gallbladder or the top of the diaphragm.Although the advantages of LMWA are obvious,at present,there is some controversy about the curative effect of LMWA on hepatocellular carcinoma,especially its postoperative recurrence rate and tumor's abdominal cavity dissemination.More than 50% of the new HCC cases in the world occur in China each year.The research about microwave ablation of HCC has been widely carried out.However,no comparison has been made between the two microwave ablation routes of LMWA and PMWA.In view of the current research status of microwave ablation,for laparoscopic treatment of HCC needs further study.OBJECTIVETo compare the difference of the curative effect between the LMWA and PMWA,and provide evidence-based evidence for the treatment of HCC by LMWA.METHODThe clinical data of 216 patients with hepatocellular carcinoma treated by microwave ablation at Department of Hepatobiliary Surgery,Hunan Provincial People's Hospital from January 2014 to April 2017 were retrospectively analyzed.The 216 cases were divided into two groups according to different operation methods,of which 78 cases were underwent laparoscopic microwave ablation(LMWA group)and 138 cases were underwent percutaneous microwave ablation(PMWA group).All cases met the following inclusion criteria:(1)single tumor diameter less than 5 cm,or multiple tumors less than 3,diameter less than 3 cm.(2)preoperative imaging,serological examination or biopsy of the tumor diagnosed as hepatocellular carcinoma.(3)liver function Child-Pugh grade A or B grade.(4)no preoperative lymph node metastasis or portal vein tumor thrombus(5)signed informed consent and follow-up information is complete.Through the operation of the newly discovered tumor lesions,tumor ablation complete rate,tumor recurrence rate,intraoperative blood loss,hospital stay,postoperative complications,local tumor progression,1,2 and 3 years after the total survival rate.The above data were statistically analyzed to compare short-term efficacy of the two surgical methods for the treatment of primary hepatocellular carcinoma.RESULT1.A total of 216 patients in the LMWA group and the PMWA group were completed the treatment of the corresponding grouping method,and the operation procedure went smoothly.Among the 15 patients(19.00%)who were underwent laparoscopic surgery and intraoperative ultrasound,tumors were not detected by preoperative imaging.These newly discovered tumors were 10.24±5.12 mm in diameter.Of these newly discovered tumors,6(40.00 %)newly discovered tumors were located near the original tumor,and 9(60.00%)newly discovered tumors were located elsewhere.2.The levels of preoperative ALT of most patients were close to normal level in LMWA and PMWA groupl.2 days after surgery,ALT levels were increased in both groups,but ALT levels were decreased in 5 days after operation.They were still higher than them in preoperation,there were no significant difference about the ALT levels between group LMWA and group PMWA(P>0.05).The levels of preoperative AST of most patients were close to normal level in LMWA and PMWA group.2 days after surgery,AST levels were increased in both groups,but ALT levels were decreased in 5 days after operation.There were no significant difference about the AST levels between group LMWA and group PMWA(P>0.05).The preoperative levels of ALB in two groups of was the normal range.2 days after surgery the levels of ALB in two groups were decreased.There was no significant difference about levels of ALB between the two groups(P> 0.05).5 days after surgery,the levels of ALB in both groups rosed back to the normal range3.There was no significant difference in hospitalization time between the LMWA group and the PMWA group(P>0.05).The median time was 5.8 days and 5.5 days,respectively.There was no significant difference in the hospitalization cost of the LMWA group(P>0.05),and the median cost was 24,689.24 yuan and 23,260.37 yuan respectively.4.The postoperative complications of patients in LMWA and PMWA group was compared.In the LMWA group,there were only 2(3.20%)cases of pneumothorax and 2(3.20%)cases of pleural effusion,no complications of Clavien-Dindo IIIa grade,such as bile leakage,intraperitoneal hemorrhage and liver failure,with no deaths.In the LMWA group,there were 8(5.00%)cases of pneumothorax,31(20.00%)cases of pleural effusion patients,no biliary leakage,intraperitoneal hemorrhage,liver failure and other complications of Clavien-Dindo IIIa or more,no deaths.5.The postoperative recurrence in LMWA and PMWA group was compared.The complete ablation rates of tumor in LMWA group and PMWA group were 93.50% and 91.00% respectively.The rate of local progression in the two groups was 7.00% and 13.00% for 1 year,10.40% and 18.00% for 2 years,and 16.00% and 25.00% for 3 years;and 1 year for both groups.The internal recurrence rates were 30.00% and 51.00%,respectively.The 2-year intrahepatic recurrence rates were 43.00% and 63.00%,respectively.The 3-year intrahepatic recurrence rates were 63.00% and 75.00%,respectively.In the laparoscopic microwave ablation group,the complete ablation rate of the tumor was higher than that of the percutaneous group,and the local progression rate and intrahepatic recurrence rate were lower.6.The total survival rate in LMWA group was higher than that in PMWA group,but there was no statistical significance(P>0.05).The 1-year survival rates were 84.40% and 80.80% respectively,the 2-year survival rates were 76.10% and 51.60% respectively,the 3-year overall survival time was 54.20% and 41.70% in LMWA and PMWA group,respectively.CONCLUSION1.Laparoscopic microwave ablation without Clavien-Dindo class IIIa complications and mild liver damage is a safe surgical method for the treatment of HCC.2.Compared with percutaneous microwave ablation,laparoscopic microwave ablation has a higher rate of complete ablation,local progression rate and low intrahepatic recurrence rate.The survival rate of patients at 1,2 and 3 years is high,and it is an effective surgical method for the treatment of HCC.