Pure Laparoscopic Liver Resection for Malignant Liver Tumor： Anatomic Resection Versus Nonanatomic Resection

Background： Laparoscopic liver resection （LLR） has been considered to be safe and feasible. However, few studies focused on the comparison between the anatomic and nonanatomic LLR. Therefore, the purpose of this study was to compare the perioperative factors and outcomes of the anatomic and nonanatomic LLR, especially the area of liver parenchymal transection and blood loss per unit area. Methods： In this study, surgical and oncological data of patients underwent pure LLR procedures for malignant liver tumor were prospectively collected. Blood loss per unit area of liver parenchymal transection was measured and considered as an important parameter. All procedures were conducted by a single surgeon. Results： During nearly 5 years, 84 patients with malignant liver tumor received a pure LLR procedure were included. Among them, 34 patients received anatomic LLR and 50 received nonanatomic LLR, respectively. Patients of the two groups were similar in terms of demographic features and tumor characteristics, despite the tumor size was significantly larger in the anatomic LLR group than that in the nonanatomic LLR group （4.77 ± 2.57 vs. 2.87 ± 2.10 cm, P = 0.001）. Patients who underwent anatomic resection had longer operation time （364.09 ± 131.22 vs. 252.00±135.21 min, P 〈 0.001） but less blood loss per unit area （7.85 ± 7.17 vs. 14.17 ± 10.43 ml/cm2, P = 0.018）. Nonanatomic LLR was associated with more blood loss when the area of parenchymal transection was equal to the anatomic LLR. No mortality occurred during the hospital stay and 30 days alter the operation. Moreover, there was no difference in the incidence of postoperative complications. The disease-free and overall survival rates showed no significant differences between the anatomic LLR and nonanatomic LLR groups. Conclusions： Both anatomic and nonanatomic pure LLR are safe and feasible. Measuring the area of parenchymal transection is a simple and effective method to estimate the outcomes of the liver resection surgery＇. Blood loss per unit area is an important parameter which is comparable between the anatomic LLR and nonanatomic LLR groups.

Safety study of Folfox-HAIC in relieving bed restriction

Objective:To investigate the safety of relieving bed restriction in hepatic arterial infusion chemotherapy(HAIC)and its effects on patient comfort.Methods:A prospective study was conducted.Patients with malignant liver tumors,who met the enrollment criteria,were randomly divided into experimental and control groups.During HAIC treatment,the patients in the experimental group,who were not confined to bed and could get out of bed,used electronic injection pumps to infuse chemotherapy drugs.The patients in the control group,who were strictly confined to bed and prohibited from getting out of bed,used infusion pumps to infuse chemotherapy drugs.The complications of the two groups were observed.The Christenson standard improved method was used to evaluate the bleeding and hematoma of limbs on the operation side.The Kolcaba General Comfort Questionnaire(GCQ)and Barthel Index(BI)were used to evaluate the two groups.Results:Ninety patients with malignant liver tumors were enrolled,including 53 with primary liver cancer and 37 with colorectal liver metastasis.There were 70 males and 20 females,aged 41-81 years old,with an average age of 61.6±9.248 years old.There were 60 patients in the experimental group and 30 patients in the control group.All patients underwent HAIC.The study showed that,during the treatment period,there were 3 cases of postoperative puncture point hematoma formation in the two groups,including 2 cases in the experimental group(2/60,3.3%)and 1 case in the control group(1/30,3.3%).The difference was not statistically significant(p>0.05).There were 5 cases of postoperative puncture point bleeding,including 4 cases in the experimental group(4/60,6.7%)and 1 case in the control group(1/30,3.3%),and the difference was not statistically significant(p>0.05).A total of 23 cases,with 6 cases in the experimental group(6/60,10%)and 17 cases in the control group(17/30,56.7%),complained of back pain after the operation,and the difference was statistically significant(p<0.05).Twenty-one cases complained of poor defecation after the operation,including 10 cases in the experimental group(10/60,16.7%)and 11 cases in the control group(11/30,36.7%).The difference was statistically significant(p<0.05).During the period of infusion chemotherapy,the two groups of patients had there was a significant difference between the two groups in terms of comfort status(GCQ)(88.78±6.705,78.47±9.519,p<0.001)and self-care ability(BI)(74.25±9.152,66.83±6.628,p<0.001).Conclusion:During HAIC treatment,getting out of bed is safe and reliable and can increase the patients’comfort and self-care ability.Hence,it merits clinical application.