Objective:To investigate the clinical value of precision liver surgery concept in the treatment of primary liver cancer.
Methods:The clinical data of 141 patients with primary liver cancer who were admitted to the No.81 Hospital of PLA from January 2009 to October 2011 were retrospectively analyzed. The three dimensional reconstruction, preoperative evaluation and virtual surgery were done based on the data of imaging examination. Hepatic functional reserve evaluation was done based on the condition of patients. The blood flow was occluded in selected patients according to the results of ultrasonography, and the tumor was anatomically resected. Patients were followed up via phone call or out patient examination till January 2014. The survival rate was calculated by Kaplan Meier method.
Results:Three dimensional reconstruction was done in 77 patients preoperatively. Thirty nine patients received ICG R15 test to detect the liver functional reserve and 95 received intraoperative color Doppler ultrasonography. The operation was successfully done on 141 patients. Four patients underwent total inflow occlusion, 48 underwent partial inflow occlusion in the hepatic pedicle by Pringle maneuver. Eighty nine patients did not receive inflow occlusion. The proportion of patients who received anatomical hepatectomy was 85.11% (120/141). The operation time, volume of intraoperative blood loss, number of patients who received blood transfusion, volume of peritoneal drainage at postoperative day 0 were (188±56)minutes, (230±100)mL, 12 and (147±58)mL, respectively. The peak levels of postoperative alanine transaminase, aspartate transaminase and total bilirubin were (219±121)U/L, (214±104)U/L and (32±14)μmol/L, respectively. Eight patients were complicated with thoracic effusion, subphrenic infection, peritoneal effusion and bile leakage, and 5 patients were complicated with pulmonary infection and incisional infection, with the complication rate of 9.22% (13/141) after the operation. All the patients were cured after symptomatic treatment, without occurrence of hepatic failure or perioperative death. The duration of postoperative hospital stay was (11.0±2.6)days. There were 130 patients with hepatocellular carcinoma and 11 patients with cholangiocarcinoma. The mean diameter of tumors resected was (5.8±1.7)cm, and the resection margin of 1 patient was positive. One hundred and thirty eight patients were followed up for (40±10)months, and the 1 , 2 , 3 year survival rates were 91.5%, 75.9% and 65.2%, and the survival time was (43±5)months.
Conclusion:Precision liver surgery has advantages of few postoperative complications and better short and long term efficacy.
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