Efficacy and safety of laparoscopic hepatectomy combined with microwave ablation in the treatment of hepatocellular carcinoma in elderly patients / 中华老年医学杂志

ABSTRACT

Objective:To investigate the efficacy and safety of laparoscopic hepatectomy combined with microwave ablation in the treatment of hepatocellular carcinoma(HCC)in elderly patients.Methods:A total of 125 elderly patients with HCC were divided into the control group(n=73)and the observation group(n=52)according to the surgical method.The control group received laparoscopic hepatectomy and the observation group underwent microwave ablation during laparoscopic hepatectomy.The operation procedures, lymphocyte subsets and postoperative recurrence were compared between the two groups.Results:The bleeding volume, drainage tube removal time and hospitalization length were lower in the observation group than in the control group( t=6.370, 7.260 and 7.136, respectively, P<0.05). CD8 levels decreased with time in both groups( Ftime=43.716, P<0.05), and the decrease of CD8 in the observation group was greater than in the control group( Ftime×group=5.179, P<0.05). The overall level of CD8 was lower in the observation group than in the control group( Fgroup=3.792, P<0.05). The levels of CD3, CD4 and CD4/CD8 increased with time in both groups( Ftime=85.692, 62.534 and 37.589, all P<0.05), and the increases of CD3, CD4 and CD4/CD8 in the observation group were greater than in the control group( Ftime×group=5.213, 6.513 and 6.721, all P<0.05). The overall levels of CD3, CD4 and CD4/CD8 were higher in the observation group than in the control group( Fgroup=6.571, 4.538 and 5.363, all P<0.05). The 2-year survival rate was higher in the observation group than in the control group(41 cases or 78.8% vs.45 cases or 61.6%, χ2=4.186, P=0.041). The 1-year and 2-year relapse-free survival rates were higher in the observation group than in the control group(1-year: 44 cases or 84.6% vs.50 cases or 68.5%, χ2=4.233, P=0.041; 2-year: 37 cases or 71.1% vs.39 cases or 53.4%, χ2=4.005, P=0.045). Conclusions:Laparoscopic hepatectomy combined with microwave ablation can improve the systemic immunity and the immunity of the microenvironment at the site of the tumor, reduce recurrence, and has better clinical outcomes.