Comparative analysis of prognosis of hepatocellular carcinoma with microvascular invasion treated by laparoscopy and open surgery

SONG Rui-peng; YUAN Yu-bin; Wang Yong-shuai; MENG Fanzheng; ZHANG Shenyu; LIU Lianxin; WANG Ji-zhou

doi:10.19538/j.cjps.issn1005-2208.2024.05.17

Abstract：Objective To investigate the prognosis of hepatocellular carcinoma patients with microvascular invasion treated by laparoscopic and open surgery.Methods Clinical data of 479 patients with hepatocellular carcinoma with microvascular invasion admitted to the First Affiliated Hospital of USTC and Heze Municipal Hospital from January 2018 to December 2023 were retrospectively analyzed.The patients were divided into a laparoscopic operation group and an open operation group.Propensity score matching(PSM)was used according to the 1∶1 nearest neighbor matching method,and there were 172 patients in each group of post laparoscopic surgery and open surgery after matching.Overall survival(OS)and tumor-free survival were compared between the two groups,and the risk factors of OS were analyzed by the Cox regression model.Results(1)Before PSM,OS was longer in the laparoscopic surgery group compared with the open surgery group(P<0.001);After matching the PSM,the OS of patients in the laparoscopic surgery group was still longer(P=0.026).(2)Before PSM,disease-free survival was longer in the laparoscopy surgery group compared with the open surgery group(P<0.001);There was no significant difference in disease-free survival time between the two groups after matching the PSM(P=0.310).(3)After PSM,compared the treatment after recurrent hepatectomy between the two groups,the proportion of re-radical surgery in the laparoscopic surgery group was higher than that in the open surgery group(P=0.010).(4)After matching the PSM,the results of multivariate COX regression analysis showed that the maximum tumor diameter≥5 cm(HR=1.11,95%CI 1.05-1.17,P<0.001)was the independent risk factor affecting the OS of patients,while radical surgery after recurrence and metastasis(HR=0.39,95%CI 0.16-0.92,P=0.031),and targeted or immunotherapy after recurrence and metastasis(HR=0.45,95%CI 0.27-0.78,P=0.004)were the protective factors for the OS of patients.Conclusion Compared with traditional open surgery,laparoscopic surgery for patients with hepatocellular carcinoma complicated with microvascular invasion has a higher proportion of re-radical surgery after recurrence and metastasis,and the OS of patients is longer.