ABSTRACT
Anatomic resection aims to improve the surgical efficacy of hepatocellular carcinoma by systematic resection of portal territory. However, due to its deviation of traditional theory and practice, the oncology effect is questionable. Anatomic resection based on portal territory(PT-AR) is planned by the analysis of real portal vein territory, and performed complete resection of tumor-bearing portal territory by fluorescent guidance, while exposing typical inter-territory hepatic vein, so as to ensure the complete function of future liver remnant. PT-AR is based on the core theory of classical anatomic resection, which will correct the deviation of traditional theory and practice from the technical level, so as to lead a better surgical oncology outcomes for hepatocellular carcinoma.
ABSTRACT
Objective:To investigate the clinical efficacy of laparoscopic anatomical right posterior sector combined with anterior-dorsal segment resection for hepatocellular carcinoma.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 15 patients with hepatocellular carcinoma who underwent laparoscopic anatomical right posterior sector combined with anterior-dorsal segment resection in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from September 2020 to August 2021 were collected. There were 9 males and 6 females, aged 66(range, 35?77)years. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect tumor recurrence and survival of patients in the postoperative 90 days. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations. All the 15 patients underwent laparoscopic anatomical right posterior sector combined with anterior-dorsal segment resection successfully, without blood transfusion and conversion to laparotomy during the operation. The operation time, volume of intraoperative blood loss and occlusion time of first porta hepatis of the 15 patients were (155±17)minutes, (254±66)mL and (51±7)minutes, respectively. (2) Postoperative situations. The duration of postoperative hospital stay of the 15 patients was (7.4±2.1)days. Results of postoperative histopathological examination showed hepatocellular carcinoma and R 0 margins in all the 15 patients with a minimum distance from margin to tumor of (1.5±0.8)cm. There was none of the 15 patients transferred to intensive care unit, perioperative death or rehospitalization within 30 days after surgery. Of the 15 patients, 2 cases had postoperative complications, including 1 case with biliary fistula (grade Ⅰ of Clavien-Dindo classification) and 1 case with ascites (grade Ⅱ of Clavien-Dindo classification). Patients with complications were improved after washing and drainage, abdominal puncture and drainage. (3) Follow-up. All the 15 patients were followed up for the postoperative 90 days and none of them had tumor recurrence or death within postoperative 90 days. Conclusion:The laparoscopic anatomical right posterior sector and anterior-dorsal segment resec-tion for hepatocellular carcinoma is safe and feasible.