ABSTRACT
Objective:To study the efficacy of laparoscopic limited anatomical hepatectomy (LLAH) for hepatocellular carcinoma (HCC) within the right anterior section.Methods:The clinical data of 144 patients with HCC confined in the right anterior section undergoing hepatectomy at the First Affiliated Hospital of Army Medical University from January 2015 to December 2022 were retrospectively analyzed, including 122 males and 22 females, aged (54.5±9.7) years. Patients were divided into LLAH ( n=27), laparoscopic anatomical hepatectomy (LAH, n=69), and laparoscopic non-anatomical hepatectomy (LNAH, n=48). Propensity score matching was used to compare the operative time, postoperative hospital stay, postoperative complications, serum total bilirubin and albumin, and the prognostic indicators such as tumor-free survival (DFS) rate and cumulative survival rate between the groups. Results:After propensity score matching, there were 26 cases each in LLAH and LNAH group. There was no significant difference in operative time, intraoperative blood loss and postoperative hospital stay between LLAH group and LNAH group (all P<0.05). The total bilirubin and albumin in LLAH on the third day after operation were [ M( Q1, Q3)] 24.1(20.9, 29.1) μmol/L and (35.8±2.9) g/L, better than those in LNAH group 39.3(33.2, 57.0) μmol/L and (33.9±2.5) g/L, respectively. The 1- and 3-year DFS rates in LLAH group were 92.3% and 57.7%, higher than those in LNAH group (80.8% and 19.2%) (all P<0.05). After propensity score matching, there were 25 patients each in LLAH and LAH group. The operative time, postoperative hospital stay and postoperative complications of LLAH group were lower than those of LAH group, and the liver function parameters of LLAH group was also better than those of LAH group (all P<0.05). There was no significant difference in DSF rate between the two groups LLAH group and LAH group ( χ2=0.10, P=0.800). Conclusions:The perioperative outcome of LLAH for HCC within the right anterior section are similar to that of LNAH and better than that of LAH. The DFS of LLAH were better than that of LNAH and similar to that of LAH.
ABSTRACT
Laparoscopic anatomic hepatectomy has become one of the therapeutic measures for hepatocellular carcinoma (HCC), which has been proven to bring both minimally invasive and survival benefits to patients from both surgical and oncological perspectives. More than 80% of HCC patients in China are complicated with cirrhosis, and the liver reserve function is impaired. Tumors often grow across liver segments or involve multiple segments. However, the application of tradi-tional laparoscopic anatomic hepatectomy is limited due to the large volume of liver resection, which is prone to lead to postoperative liver failure. Based on the bio-oncological characteristics of HCC and the limitations of traditional laparoscopic anatomical hepatectomy, the concept and practice of laparoscopic limited anatomical hepatectomy (LLAH) came into being. LLAH, also known as hepatic parenchyma-preserving anatomical hepatectomy, is based on the tumor lesion as the center, the portal territory with tumor as the reference plane, and anatomical relationship between tumor location and the sub-hepatic segment or hepatic segment as the principle to remove the tumor and its subsegment or hepatic segmental portal territory. Its core concept is to maximize the preser-vation of functional liver parenchyma on the premise of ensuring oncological resection. The main surgical procedures of LLAH include anatomical subsegmental resection, segmentectomy and combined subsegmental/segmental resection with preservation of liver parenchyma. Its main indica-tion is small or micro hepatocellular carcinoma located between subsegments/segments. Navigation technologies such as three-dimensional visualization, laparo-scopic ultrasound, and indocyanine green fusion fluorescence are used to achieve anatomical hepatectomy with tumor and its oncolo-gical safety margin as the center through the splicing and combination of multiple subsegments/segments. The purpose of resection of the liver tissue in the portal territory with tumor and preser-vation of the functional liver structure and volume are achieved to the maximum extent after LLAH. At present, LLAH for HCC is still in the exploratory stage, and its long-term oncology results need to be further studied. However, with technological progress and concept update, LLAH will surely become the core method for minimally invasive and precise treatment of HCC. Combined with related researches at at home and abroad, the authors describe the concept and development, theoretical and technical supports, oncological safety and development trends of LLAH.