Short-Term Clinical Efficacy Analysis Of Laparoscopic Anatomical Liver Resection For Hepatocellular Carcinoma

Background: Surgical resection remains the preferred treatment for hepatocellular carcinoma.Laparoscopic surgery has been recognized by all medical centers due to its advantages of small trauma,low complication rate and rapid postoperative recovery,and it has been widely carried out and used.While there are few studies related to the clinical outcomes of laparoscopic anatomical liver resection(LALR)and laparoscopic non-anatomical liver resection(LNALR)for hepatocellular carcinoma(HCC).At the same time,indocyanine green(ICG)fluorescence navigation technology,as an emerging technology,has not been widely carried out in LALR.The purpose of this study was to investigate the short-term clinical efficacy of LALR and LNALR in the treatment of HCC,and to further study the role of ICG fluorescence navigation in the treatment of HCC with LALR.Methods: A total of 220 cases were retrospectively and statistically collected from patients who were diagnosed with HCC by pathologic findings and surgically treated by laparoscopy in Jinhua Municipal Central Hospital from October 2017 to September 2022.The included patient information was divided into LALR group and LNALR group according to the surgical resection method,including a total of 90 cases in LALR group and 130 cases in LNALR group.Whereas in the LALR group,subgroup analysis was performed according to whether the ICG fluorescence navigated technique was used intraoperatively,in which there were 12 cases in the ICG group and 78 cases in the non ICG group.Baseline data such as age,hepatitis B,cirrhosis,and liver function were analyzed with propensity score matching(PSM)between groups according to the 1:1 proximity method,and subsequently to compare and analyze the intraoperative outcomes including operative time,intraoperative blood loss,and intraoperative blood transfusion,as well as postoperative outcomes such as postoperative liver function,postoperative complications,postoperative hospital stay,and 30 th and 90 th day mortality in each subgroup.Results: Before PSM,there were significant differences in baseline characteristics such as hepatitis B,cirrhosis and tumor size between the LALR and LNALR groups(P < 0.05).After PSM,there was no significant difference in baseline characteristics between the LALR group and the LNALR group(P > 0.05).The intraoperative results showed that the LALR group had a significantly longer operation time(234.2 ± 99.3 min vs.156.1 ± 55.4 min,P <0.001)and significantly less intraoperative blood transfusion than the LNALR group(59.5 ±190.4 ml vs.191.4 ± 349.1 ml,P = 0.020),along with a lower conversion to open rate(1.6%vs.20.3%,P = 0.003).Postoperative outcomes showed that LALR group had lower postoperative day 1 total bilirubin(TBIL)[22.7(13.6)umol/L vs.29.2(22.4)umol/L,P =0.002] and postoperative day 3 alanine transaminase(ALT)[101.0(72.8)U/L vs.130.9(158.8)U/L,P = 0.035] than LNALR group.Both groups were comparable in terms of postoperative complications,duration of postoperative hospital stay,and no patient deaths occurred between 30 th and 90 th days after surgery.Subgroup analyses revealed that each baseline characteristic was comparable before and after PSM for both the ICG and non ICG groups.The ICG group had a relatively longer operation time and less intraoperative blood loss than the non ICG group,and no significant differences were observed because of the number of cases.Both groups had similar rates of postoperative liver function recovery,with no major complications and a 30-and 90 day mortality of 0.Conclusions:1.Compared with laparoscopic non-anatomical liver resection,laparoscopic anatomical liver resection has high surgical technical requirements and relatively long operation time,but it can reduce intraoperative blood transfusion volume and does not improve the postoperative complication rate and mortality,thus being a safe and feasible operation method.2.Indocyanine green fluorescence navigated laparoscopic anatomical liver resection is a safe and effective surgical technique that requires a certain learning curve to be skillful.