Effect of CLCVP during complex laparoscopic hepatectomy on perioperative indicators and prognosis in patients with hepatocellular carcinoma

Abstract

Abstract: Objective To investigate the influence of controlled low central venous pressure (CLCVP) in complex laparoscopic hepatectomy on perioperative indicators and prognosis of liver cancer patients. Methods A total of 124 patients with primary liver cancer (PLC) admitted to our hospital from May 2018 to May 2019 were included in the study. They were divided into an observation group and a control group according to the random number table, with 62 patients in each group. The control group underwent complex laparoscopic hepatectomy, and the observation group underwent CLCVP added to complex laparoscopic hepatectomy. The perioperative clinical indicators (operation time, intraoperative blood loss, intraoperative blood transfusion, portal block time and hospital stay) and incidence of postoperative complications were compared between the 2 groups. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine (SCr), and blood urea nitrogen (BUN) levels were compared before and after surgery in the 2 groups. Moreover, the patients in both groups were followed up for 1 year after operation, and the 1-year postoperative survival rate was calculated. Results All the perioperative indexes in the observation group were better than those in the control group (P<0.05). There was no significant difference in the levels of ALT, AST, SCr, BUN before operation, or the levels of SCr and BUN 3 and 7 days after operation between the 2 groups (P>0.05). The levels of ALT and AST in the observation group were significantly lower than those in the control group before operation, 3 and 7 days after operation (P<0.05). There was no significant difference in the incidence of postoperative complications between the 2 groups (9.68% vs 6.45%, P>0.05). With no cases lost during the 1-year follow-up, there was no statistical difference in the 1-year postoperative survival rate between the 2 groups (82.26% vs 80.65%, P>0.05). Conclusion CLCVP during complex laparoscopic hepatectomy shortens the operation time and hospital stay, reduces intraoperative blood loss, and has no adverse effect on the complications and prognosis of patients with primary liver cancer.

Key words: Primary liver cancer, Laparoscope, Hepatectomy, Liver function, Complications, Prognosis

LV Fa-kai, WANG Deng-ji, XIE Yu-hui, ZHANG Yu. Effect of CLCVP during complex laparoscopic hepatectomy on perioperative indicators and prognosis in patients with hepatocellular carcinoma[J]. Chinese Hepatolgy, 2021, 26(7): 761-764.

References

[1] O'Conor GT, Tatarinov YS, Abelev GI, et al. Collaborative study for the evaluation of a serologic test for primary liver cancer. Cancer, 2015, 25:1091-1098.
[2] Nakashima T, Okuda K, Kojiro M, et al. Primary liver cancer coincident with schistosomiasis japonica. a study of 24 necropsies. cancer, 2015, 36:1483-1489.
[3] Cheung T, Dai W, Tsang H, et al. Pure laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 110 patients with liver cirrhosis. Ann Surg, 2016, 264:612-620.
[4] Soubrane O, Schwarz L, Cauchy F, et al. A conceptual technique for laparoscopic right hepatectomy based on facts and oncologic principles. Ann Surg, 2015, 261:1226-1231.
[5] Feng ZY, Xu X, Zhu SM, et al. Effects of low central venous pressure during preanhepatic phase on blood loss and liver and renal function in liver transplantation. World J Surg, 2010, 34:1864-1873.
[6] Rahbari NN, Koch M, Zimmermann JB, et al. Infrahepatic inferior vena cava clamping for reduction of central venous pressure and blood Loss during hepatic resection. Ann Surg, 2011, 253:1102-1110.
[7] 中华人民共和国卫生部. 原发性肝癌诊疗规范(2011年版). 中华肝脏病杂志, 2012, 20:929-946.
[8] Xie X, Yao M, Chen X, et al. Reduced red blood cell count predicts poor survival after surgery in patients with primary liver cancer. Medicine, 2015, 94:1-8.
[9] 王秀清, 马艳君, 詹晋莉. 肝动脉化疗栓塞术联合超声引导下微波消融术治疗特殊部位原发性肝癌患者疗效及安全性分析.实用肝脏病杂志, 2019, 22:260-263.
[10] Chassagne F, Rojas Rojas T, Bertani, Stéphane, et al. A 13-year retrospective study on primary liver cancer in cambodia: a strikingly high hepatitis c occurrence among hepatocellular carcinoma cases. Oncology, 2016, 91:106-116.
[11] Watanabe J, Ota M, Fujii S, et al. Randomized clinical trial of single-incision versus multiport laparoscopic colectomy: Single-incision versus multiport laparoscopic colectomy. British J Surg, 2016, 103:1276-1281.
[12] Chen S, Huang L, Qiu FN, et al. Total laparoscopic partial hepatectomy versus open partial hepatectomy for primary left-sided hepatolithiasis: a propensity, long-term follow-up analysis at a single center. surgery, 2018, 163:714-720.
[13] Xu HW, Li HY, Liu F, et al. Totally laparoscopic associating liver tourniquet and portal vein occlusion for staged hepatectomy combined with simultaneous left hemicolectomy for bilateral liver metastases of the primary colon cancer: a case report. Medicine, 2017, 96:1-3.
[14] Wang Y, Wang W, Ge R, et al. Continuous portal triad clamping in hepatectomy for primary liver cancer with chronic liver disease: a prospective controlled study. J Clin Oncol, 2015, 33:15165-15165.
[15] Chan A, Chok KSH, Cheung TT, et al. Is Laparoscopic major hepatectomy superior to open major hepatectomy for liver cancer? a matched case-control study. J Am Coll Surgeons, 2017, 225:31-32.
[16] Zhu XS, Wang SS, Cheng Q, et al. Using ultrasonography to monitor liver blood flow for liver transplant from donors supported on extracorporeal membrane oxygenation. Liver Transpl, 2016, 22:188-191.
[17] Bissig KD, Paust S, Barzi M . Liver is liver and blood is blood, and finally the twain have met. J Hepatol, 2016, 65:245-248.
[18] 陈江明, 耿小平. 肝脏外科的永恒话题:出血与止血. 中华普通外科杂志, 2018, 33:439-441.
[19] 魏珂, 程波, 何开华,等. 控制性低中心静脉压用于不同类型肝切除术患者的血液保护效应. 中华麻醉学杂志, 2013, 33:1451-1453.
[20] 张日新, 朱岭, 汪娟,等. 控制性低中心静脉压在肝切除术中的应用. 中华实验外科杂志, 2016, 33:2324-2326.