Comparison of the Efficacy of Anatomic and Non-anatomic Hepatectomy for Hepatic Alveolar Echinococcosis: Clinical Experience of 240 Cases in a Single Center

Abstract

BackgroundHepatic alveolar echinococcosis (AE) is a zoonotic parasitic disease. There are more than 16,000 new cases each year, approximately 60 million people are threatened, and the annual direct economic loss is RMB 3 billion. The prevalence of AE in some areas of the Qinghai–Tibet Plateau is as high as 6.0%. Radical resection, including anatomic and non-anatomic hepatectomy, for advanced AE can significantly prolong the survival time of patients. However, there is no literature compared the efficacy of anatomic and non-anatomic hepatectomy. Therefore, by comparing various clinical evaluation indices between anatomic and non-anatomic hepatectomy, this study explored the short-term and long-term efficacy of these two surgical methods for AE.MethodsThe clinical data of patients with AE who underwent radical hepatectomy at Qinghai Provincial People's Hospital from January 2015 to January 2021 were retrospectively analyzed. The patients were divided into two groups by surgical method, that were, non-anatomic hepatectomy group and anatomic hepatectomy group. We compared these two groups focusing on basic preoperative data, such as age, sex, lesion size, and liver function parameters; main intraoperative evaluation indices, such as operation time, intraoperative porta hepatis occlusion time, intraoperative blood loss, and blood transfusion; and postoperative recovery evaluation indicators, such as postoperative liver function, incidence of surgical complications, and AE recurrence.ResultsA total of 240 patients were enrolled in this study, including 123 in anatomic hepatectomy group and 117 in non-anatomic hepatectomy group. There were no significant differences (P > 0.05) between baseline characteristics. Anatomic hepatectomy group was advantageous than non-anatomic hepatectomy group regarding intraoperative blood loss (P < 0.001), blood transfusion (P < 0.001), and porta hepatis occlusion time (P < 0.001). There were statistically significant differences in postoperative liver function (aspartate aminotransferase: P < 0.001; alanine aminotransferase: P < 0.001), surgical complications (P < 0.001), and AE recurrence rate (P = 0.003). The median survival of patients in the anatomic hepatectomy group was 66 months, compared to 65 months in the non-anatomic hepatectomy group (χ2 = 4.662, P = 0.031).ConclusionsAnatomic hepatectomy was not only safe for AE but also showed better short-term and long-term superiority than non-anatomic hepatectomy.

Application of Laennec extrathecal blockade combined with indocyanine green fluorescence imaging in laparoscopic anatomic hepatectomy

“…The classification of the region of the third or fourth branch of the portal vein into a hepatectomy unit based on the liver segmentation method of the portal vein basin conforms to the surgical principle of anatomical hepatectomy and can assist the accurate implementation of anatomical hepatectomy, which has been recognized by hepatobiliary surgery experts all over the world 4,5 . In anatomical hepatectomy, it is vital significance to correctly judge the boundary between precut liver segment and liver lobe, which is helpful to control intraoperative bleeding and accurate resection of liver segment and liver lobe and it is also the difficulty in anatomical hepatectomy 6 . At present, some studies believe that Laennec membrane is the liver proper membrane, which can be used as the anatomical gap between the liver and the Glisson pedicle and the hepatic vein.…”

“…4,5 In anatomical hepatectomy, it is vital significance to correctly judge the boundary between precut liver segment and liver lobe, which is helpful to control intraoperative bleeding and accurate resection of liver segment and liver lobe and it is also the difficulty in anatomical hepatectomy. 6 At present, some studies believe that Laennec membrane is the liver proper membrane, which can be used as the anatomical gap between the liver and the Glisson pedicle and the hepatic vein. It has been gradually paid attention to by liver surgeons and applied to anatomical hepatectomy, 7,8 Indocyanine green (ICG) is a near-infrared fluorescent dye, which can be specifically taken up by hepatocytes and excreted through bile after intravenous injection, and has good biosafety, 9 Since it was first reported for hepatectomy in 2008, ICG has been gradually widely used in liver surgery and plays an important role in accurate liver surgery.…”