Efficacy Of Radical Hepatectomy Combined With Microwave Ablation In Treatment Of Primary Hepatocellular Carcinoma With Microvascular Invasion

Background and Objects: Primary hepatocellular carcinoma(PHC)is a common malignancy in our country.Radical hepatectomy(RH)is the first choice for the treatment of primary liver cancer,but the high postoperative recurrence rate results in short overall survival and poor treatment.Microvascular invasion(MVI)is an independent risk factor for recurrence after hepatectomy.The diagnosis of MVI depends on postoperative pathological examination.There is no effective prediction and prevention.This study compared the efficacy of simple hepatectomy and hepatectomy combined with microwave ablation(MWA)in the treatment of primary hepatocellular carcinoma complicated with microvascular invasion,to explore whether it is safe and effective to treat primary hepatocellular carcinoma with microvascular invasion by comparing disease-free survival and overall survival of postoperative patients.Methods: Collecting patients with clinically diagnosed primary liver cancer at the General Surgery Department of the 180 th Hospital of the Chinese People's Liberation Army from March 2013 to June 2017,performing hepatectomy and microwave ablation on patients with high risk of microvascular tumor embolism and meeting economic conditions and surgical conditions.The remaining patients were subjected to hepatectomy.According to the postoperative pathological results,patients without microvascular thromboses were excluded.Patients with hepatocellular carcinoma combined with microvascular thrombus after microwave ablation were included in the treatment group.Only hepatectomy with hepatic cancer and microvessels was included.Patients with cancer emboli were included in the control group.In the above-mentioned patients,biochemical liver function,AFP,abdominal color Doppler ultrasound,or CT were detected at least once a month within the first 6 months after surgery,and biochemical liver function,AFP,and abdominal ultrasound were reviewed at least every 3 months after 6 months.CT,further investigation of ultrasound contrast or enhanced CT or MRI in patients with suspected recurrent lesions.Clinical data collection and follow-up for patients were as of December 31,2017.Through a comparative analysis of disease-free survival and complications in the two groups of patients,we investigated whether radical hepatectomy combined with microwave ablation can benefit patients with hepatocellular carcinoma associated with microvascular thrombosis.Results: 1? The 22 patients in the treatment group had an average DFS of 26.6 months and a control group of 36 patients.The average DFS of the patients was 22.1 months,with a statistically significant difference(P=0.001).The patients were classified as having microvascular tumor thrombosis and no tumors.Survival period,28 patients with type M1,mean DFS was 26.1 months,M2 patients were 30,DFS averaged 21.5 months,the difference was statistically significant(P=0.004);in treatment group,17 patients were M1 type The average value of DFS was 41.4 months.There were 5 patients with M2 type and the mean DFS was 21.4 months.The difference was statistically significant(P=0.048).2? Through multi-factor COX model analysis,hepatectomy combined with microwave ablation therapy,MVI type,and maximum tumor diameter were relatively independent factors influencing patients' DFS.Hepatectomy combined with microwave ablation was a protective factor,M2 type MVI and maximum tumor diameter> 5cm are risk factors.3? Adverse reactions after surgery included bleeding,fever,nausea and vomiting,elevated transaminases,and effusion in the perioperative area.Among them,there were 2 cases in the treatment group with more than 500 ml of intraoperative hemorrhage and 14 were in the control group.The difference was statistically significant(P=0.014).The remaining adverse reactions were not statistically different in the two groups.Conclusion:.1?Overall,radical resection combined with microwave ablation of primary hepatocellular carcinoma with microvascular thrombectomy prolongs the disease-free survival of patients compared with radical radical resection,creating conditions for further prolonging overall survival and improving quality of life.It is a safe and effective treatment.2?The maximum diameter of the tumor greater than 5cm and the M2 type MVI are risk factors for tumor recurrence.This provides new ideas for clinical work.For patients with tumor diameter greater than 5cm,intraoperative microwave ablation can benefit patients;for M2 patients with MVI Postoperatively,the development of the tumor should be closely monitored to create conditions for the early detection and early treatment of the tumor.3?Hepatectomy combined with microwave ablation is a safe treatment method compared with simple hepatectomy in the treatment of hepatocellular carcinoma with microvascular thrombus,which can effectively reduce intraoperative blood loss and does not produce more adverse reactions.