Stress response, complications, and postoperative recovery in patients with hepatocellular carcinoma and comorbid anxiety/depression undergoing ultrasound-guided intervention.

[BACKGROUND] Hepatocellular carcinoma (HCC) is a common and frequently encountered malignancy in clinical practice. Patients who lack understanding of the disease and surgical treatment are prone to fear, depression, and other negative emotions, which further aggravate psychological stress. As such, less stimulating and minimally invasive surgical modalities, such as ultrasound-guided interventions, should be adopted to alleviate or eliminate negative perioperative psychological states, which can be evaluated using validated tools such as the Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D).

[AIM] To investigate the impact of ultrasound-guided surgery on stress, complications, and recovery in patients with HCC and comorbid anxiety/depression.

[METHODS] Ninety patients with primary small HCC and comorbid anxiety/depression were randomly divided into 2 groups according to treatment ( = 45 each): Experimental (ultrasound-guided intervention); and control (conventional laparoscopic hepatectomy). The HAM-A and HAM-D were used to assess psychological states before and 1 week after surgery. C-reactive protein (CRP), vascular endothelial growth factor (VEGF), and superoxide dismutase (SOD) levels, in addition to specific liver-function indicators, complication rates, and postoperative metrics were measured. Recurrence rates were monitored for 6 months.

[RESULTS] There were no significant differences in preoperative HAM-A and HAM-D scores between the 2 groups ( > 0.05); however, scores in the study group were significantly lower postoperatively ( < 0.05). On postoperative day 1, there were no significant differences in serum levels of CRP, VEGF, or SOD between the groups ( > 0.05), whereas the levels in the intervention group were significantly lower than those in the control group on days 3 and 7 ( < 0.05). The incidence of postoperative complications in the study group (6.66%) was significantly lower than that in the control group [17.78% ( < 0.05)]. The study group also had a significantly shorter time to first flatus, oral intake, and postoperative hospital stay ( < 0.05). Postoperative serum alanine aminotransferase, aspartate aminotransferase, and total bilirubin levels decreased in both groups compared with preoperative levels, although with significantly lower values in the study group ( < 0.05) but no differences preoperatively ( > 0.05). There was no statistical difference in tumor recurrence rates between the 2 groups during the six-month follow-up ( > 0.05).

[CONCLUSION] Ultrasound-guided intervention for patients with primary small HCC and anxiety/depression effectively improves negative emotional states, reduce stress responses, decreases postoperative complications, promotes recovery, and enhances quality of life.