KẾT QUẢ SỚM PHẪU THUẬT CẮT GAN THEO GIẢI PHẪU ĐIỀU TRỊ UNG THƯ BIỂU MÔ TẾ BÀO  GAN Ở NGƯỜI CAO TUỔI TẠI BỆNH VIỆN QUÂN Y 175

Quỳnh Nguyễn Văn; Thảo Trịnh Văn; Mạnh Nguyễn Văn; Trung Lê Đức; Huy Đoàn Thanh; Khỏe Nguyễn Mạnh

doi:10.59354/ydth175.2024.287

Keywords:

Anatomical hepatectomy, hepatocellular carcinoma in the elderly, 175 Military Hospital

Abstract

Objective: Short-term outcomes of anatomical hepatectomy to treat hepatocellular carcinoma in the elderly at 175 Military Hospital.

Subject and method: Descriptive, retrospective and prospective study of elderly patients undergoing anatomical hepatectomy to treat hepatocellular carcinoma at 175 Military Hospital from 1/2022 to 5/2024.

Result: Hepatectomy was performed for 30 patients. Average age: 68.4 ± 6.8 years. 90.0% of patients are men. Clinical symptoms: abdominal pain was the most common (33.3%), 56.7% cases were discovered liver tumors accidentally. The incidence of hepatitis B was 76.7%, hepatitis C was 10.0%. Average AFP index was 497.7 ± 931.1 ng/ml. Preoperative computed tomography: solitary tumor 80.0%, tumor < 5cm 73.3%, tumor > 5cm 26.7%, tumor > 10cm 13.3%, abdominal fluid 6.7%. Preoperative liver function: Child - Pugh A 100%. In 30 cases, 83.3% using Takasaki’s Glissonean pedicles approach. Major hepatectomy 23.3%, minor hepatectomy 76.7%. Anatomical liver resection 100%, including right anterior hepatectomy 23.3%, left hepatectomy 16.7%, left lateral hepatectomy 16.7%, right hepatectomy 6.7%, subsegmental 5-6 hepatectomy 10.0%. Liver parenchymal transection: 100% use harmonic scalpel. The mean operation time was 164.2 ± 44.1 minutes. The mean blood loss was 232.7 ± 88.3 ml, the need for blood transfusion was required in 36.7%. The average length of hospital stay was 9.2 ± 4.5 days. Postoperative complications: pleural effusion (43.3%), ascites (3.3%), bile leakage (3.3%), surgical wound dehiscence (3.3%). The classification of complications according to Clavien were: I (43.3%), II (3.3%), IIIa (3.3%), IIIb (3.3%). There was no perioperative mortality.

Conclusion: Short-term outcomes of anatomical hepatectomy to treat hepatocellular carcinoma in the elderly at 175 Military Hospital was safe and effective.

References

Rajesh Sharma. (2020) Descriptive epidemiology of incidence and mortality of primary liver cancer in 185 countries: evidence from GLOBOCAN 2018. Japanese Journal of Clinical Oncology.50(12):1370–1379.

Schwartz J.M., Carithers R.L. (2018) Epidemiology and etiologic associations of hepatocellular carcinoma. wwwuptodatecom.

Wen-Ping Lu, Jia-Hong Dong. (2014) Hepatectomy for hepatocellular carcinoma in the era of liver transplantation. World J Gastroenterol.20(28):9237-9244.

Manon Allaire, Claire Goumard, Chetana Lim, et al. (2020) New frontiers in liver resection for hepatocellular carcinoma. JHEP Reports.2:1-14.

Sudip Sanyal, Philipp Kron, Neil Wylie, et al. (2020) Outcomes of liver resection for hepatocellular carcinoma in octogenarians. HPB.22:1324–1329.

Danijel Galun, Aleksandar Bogdanovic, Marko Zivanovic, et al. (2021) Short- and Long-Term Outcomes After Hepatectomy in Elderly Patients with Hepatocellular Carcinoma: An Analysis of 229 Cases from a Developing Country. Journal of Hepatocellular Carcinoma.8:155–165.

Hidekazu Yamamoto, Masaki Kaibori, Hideyuki Matsushima, et al. Efficacy and Safety of Liver Resection in Super Elderly Patients with Hepatocellular Carcinoma. Asian Pacific Journal of Cancer Prevention.24:1089-1094.

Chuan-Ming Wang, Zi-Xiang Chen, Ping-Chuan Ma, et al. (2023) Oncological prognosis and morbidity of hepatectomy in elderly patients with hepatocellular carcinoma: a propensity score matching and multicentre study. BMC Surgery.23(323):1-11.

Vũ Văn Quang. (2018) Nghiên cứu ứng dụng kỹ thuật kiểm soát cuống glisson theo Takasaki trong cắt gan điều trị ung thư biểu mô tế bào gan tại bệnh viện Trung ương Quân đội 108. Viện nghiên cứu khoa học y dược học lâm sàng 108.

Dương Huỳnh Thiện. (2016) Đánh giá kết quả sớm phẫu thuật cắt gan điều trị ung thư tế bào gan tại bệnh viện Chợ Rẫy. Y học Thành phố Hồ Chí Minh.20(1):135-140.

Yamazaki O., Matsuyama M., Horii K., et al. (2010) Comparison of the outcomes between anatomical resection and limited resection for single hepatocellular carcinomas no larger than 5 cm in diameter: a single-center study. Journal of hepatobiliary-pancreatic sciences.17(3):349-358.

Huang X., LuS. (2017) A Meta-analysis comparing the effect of anatomical resection vs. non-anatomical resection on the long-term outcomes for patients undergoing hepatic resection for hepatocellular carcinoma. HPB.19(10):843-849.

Tan Y., Wei Zhang, Li Jiang, et al. (2017) Efficacy and safety of anatomic resection versus nonanatomic resection in patients with hepatocellular carcinoma: A systemic review and metaanalysis. PLoS ONE.12(10)