To explore the effect of preoperative liver hardness on the safety of laparoscopy and laparotomy for hepatocellular carcinoma.

The clinical data of 281 patients with liver cancer treated in our hospital from Feb 2014 to Aug 2018 were retrospectively analyzed, and the patients were divided into the laparoscopic group (n=68) and the laparotomy group (n=213) according to their treatment methods. The clinical data, preoperative liver hardness, postoperative recovery and complications of the two groups were compared, and the influence of different liver hardness values on the risk of postoperative complications was analyzed. SPSS 22.0 software was used for statistical analysis. Counting data were expressed as (n/%) and χ² was used for statistical analysis. Measuring data were expressed as (±s) and T test was used for risk factor analysis. Logistic regression method was used for risk factor analysis. ROC curve was used for predictive effectiveness analysis, with P<0.05 as the statistical difference.

The intraoperative Pringle occlusion rate in the laparoscopic group was higher than that in the open group (P<0.05). There was no significant difference in preoperative liver stiffness between the two groups (P>0.05). The incidence of postoperative complications in the laparoscopic group (liver hardness value>15.0 kpa) was higher than that in the open group (P<0.05). Logistic multivariate regression analysis showed that liver hardness value >15.0 kpa was an independent risk factor for postoperative complications of liver cancer (P<0.05). Using the liver hardness value>15.0 kpa as the cut-off value, the area under the curve (AUC) for predicting postoperative complications in patients with liver cancer was 0.759, and its sensitivity and specificity were 65.3% and 83.9%, respectively.

The patients of liver cancer with preoperative liver hardness value>15.0 kpa have a higher risk of postoperative complications. For such patients, open surgery should be considered to improve surgical safety.