The clinical and pathologic characteristics of the patients with HCC.
In our study, the mean ages of the patients in the LR and HSAL groups were (57.16±10.12) years and (54.85±11.97) years, respectively. The mean white blood cell (WBC) count was (3.46±1.32) 109/L, the mean hemoglobin (Hb) level was (126.52±22.24) g/L, and the mean platelet count was (72.60±30.80) 109/L. The serum albumin levels of the patients in the LR and LRSL groups were (39.73±4.09) g/L and (38.99 ± 6.41) g/L, respectively. The percentage of male patients was 77.33% (n=58), and the HBV-positive percentage was 92.0% (n=69). From Table 1, we found that the WBC and platelet counts, serum albumin level, total bilirubin (Tbil) level, PT, etc., were not significantly different between the LR and HSAL groups (P>0.05).
Liver function after surgery in patients with HCC.
To analyze liver function in HCC patients who underwent surgery, we collected liver function on day 3 after surgery. We found that the WBC count and alanine aminotransferase (ALT) level were significantly different between the LR and HSAL groups (P<0.05). However, the albumin, Hb, and Tbil levels and the PT, etc., were not significantly different (P>0.05) (Table 2). We found that the patients in the HSAL group had a lower ALT level than those in the LR group, and we may conclude that HSAL can reduce damage to liver function.
Then, we analyzed liver function on day 5 after the operation and found that the Tbil levels in the LR group and HSAL group were (28.49 ± 13.54) μmol/L and (19.55 ± 8.48) μmol/L, respectively (P=0.03). The PTs in the LR group and HSAL group were (16.22 ± 2.5) s and (15.58± 1.62) s, respectively (P=0.001). The Hb, albumin, Tbil, and ALT levels were not significantly different between the LR and LRSL groups (P>0.05) (Table 3). We found that the LR group patients had worse liver function on day 5 postoperation and that the HSAL group patients easily recovered liver function. We hypothesize that HSAL can significantly protect liver cells and promote the recovery of postoperative liver function.
The hospital stays, operation time, bleeding volume, and number of transfusions in the LR and HSAL groups
The hospital stays in the patients with HCC in the LR and HSAL groups was (20.39 ± 7.35) and (17.9 ± 4.84) days, respectively (P>0.05). The operation time in the LR and HSAL groups was (164.31 ± 55.38) min and (176.08 ± 62.44) min, respectively (P=0.22). The amount of bleeding during the operation in the LR and HSAL groups was (467.74 ± 428.31) mL and (550.0 ± 443.47) mL, respectively (P=0.73) (Table 4).
We also analyzed the number of transfusions, including plasma, concentrated red blood cells, cryoprecipitates, and platelets, in the HCC patients, and this number was not significantly different in the two groups (P>0.05) (Table 4). We found that HSAL did not increase the length of hospital stay, operation time, bleeding volume, or number of transfusions, and we may conclude that HSAL is safe for HCC patients.
The analysis of postoperative complications in patients with HCC.
We collected clinical data regarding complications to analyze the differences in the treatment groups. The percentage of PHLF in the LR and HSAL groups was 22.58% and 7.69%, respectively, and the percentage of PHLF in the HSAL group was significantly lower than that in the LR group. In the LR group, one patient died due to PHLF after the operation, but in the HSAL group, all the patients recovered well after operation. We also found that the rates of death, abdominal infection, biliary fistula, hepatic encephalopathy, intra-abdominal hemorrhage, hydrothorax, and ascites were not significantly different (P>0.05) (Table 5). These findings demonstrated that HSAL did not increase the incidence of postoperative complications and LRSL is safe for HCC patients.
Spleen volume was correlated with PHLF in patients with HCC
While analyzing the data, we unexpectedly found that there were statistically significant differences in spleen volume between the PHLF and non-PHLF groups. The spleen volumes in the PHLF and non-PHLF groups were (724.5 ± 87.75) cm3 and (523.4 ±34.24) cm3, respectively (P=0.016) (Figure 2-A). We used receiver operating characteristic (ROC) curve analysis the spleen volume and PHLF, and the ROC area under the curve was 0.68 (P=0.032). The cut-off value of the spleen volume was 639 cm3 (the sensitivity was 72%, 95% CI: 59% to 83%; the specificity was 67%, 95% CI: 38% to 88%) (Figure 2-B). Therefore, PHLF is more likely to occur in HCC patients with a spleen volume over 639 cm3, and these patients underwent HSAL may be more beneficial to the recovery of postoperative liver function. Therefore, spleen volume can be used to predict the risk of PHLF and guide the choice of surgical approach for HCC patients.