Effects of the support system combined with Chinese medicine on postoperative gastrointestinal recovery in patients with liver cancer

Abstract

BACKGROUND

The treatment of patients with liver cancer after surgery with the artificial liver support system combined with traditional Chinese medicine (TCM) for strengthening the body and removing blood stasis is a new idea.

AIM

To analyze the post-surgical effect of the artificial liver support system with TCM in patients with liver cancer.

METHODS

Ninety-eight patients with liver cancer who underwent surgical treatment at the Fifth People’s Hospital of Huai’an from January 2023-2024 were selected and divided into two groups (49 patients each) via random lottery method. Both groups underwent surgery. The control group received artificial liver support, and the observation group was additionally treated with TCM for strengthening the body and removing blood stasis. Gastrointestinal recovery, liver function, tumor marker levels, immune function, and safety were compared between both groups.

RESULTS

There were significant differences in the levels of indicators related to gastrointestinal recovery between the groups (P < 0.05). After treatment, the levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin, and gamma-glutamyl transpeptidase in the observation group were lower, whereas the albumin level was higher (P < 0.05). After treatment, tumor marker levels in the observation group were relatively lower (P < 0.05). After treatment, compared to the control group, the CD4+ level in the observation group was higher and the CD8+ level was lower (P < 0.05). There was no significant difference in the incidence of adverse reactions between both groups (P > 0.05).

CONCLUSION

Combining the artificial liver support system with TCM significantly improves liver and gastrointestinal functions, enhances immune responses, and reduces tumor marker levels with high safety, suggesting that it could be a promising approach for optimizing postoperative care and improving patient outcomes, potentially reducing complications and enhancing quality of life.

Key Words: Artificial liver support system; Traditional Chinese medicine; Agents for strengthening the body and removing blood stasis; Liver cancer; Postoperative; Liver function

Core Tip: Postoperative interventions play a crucial role in enhancing recovery in patients with liver cancer, especially following surgical treatments such as transcatheter arterial chemoembolization. This study demonstrates that combining an artificial liver support system with traditional Chinese medicine aimed at strengthening the body and removing blood stasis can significantly improve liver function, promote gastrointestinal recovery, regulate immune function, and lower tumor marker levels. The approach maintains high safety and may offer a comprehensive, integrative strategy to improve clinical outcomes, reduce complications, and enhance the quality of life for postoperative liver cancer patients.

INTRODUCTION

Liver cancer is a malignant tumor of the liver. In the early stages, the symptoms are often indistinct or atypical. Some patients may experience symptoms such as pain in the liver area, digestive tract symptoms (e.g., loss of appetite or abdominal distension), and fever. A small number of patients may also present with hypercalcemia, hypoglycemia, polycythemia, and other symptoms. These manifestations can lead to impaired liver function and a decline in the immune system; they may even affect the function of other organs, endangering the patient’s life[1].

Currently, treatment methods for liver cancer include drug therapy and surgery. Surgery is the primary treatment for patients with early stage of liver cancer, limited lesions, and relatively good overall health. Surgical treatment methods for patients with liver cancer primarily include liver transplantation, liver cancer resection, and microwave radiofrequency ablation. The survival period of patients can be extended by removing tumor tissues. However, liver cancer surgery can damage patients, leading to surgery-related adverse reactions such as abnormal gastrointestinal function and immune function disorders, which affect patient outcomes[2]. Therefore, in addition to surgery, patients with liver cancer often require adjuvant treatment.

The artificial liver support system is important when treating liver diseases. Through an invitro physical, chemical, or biological device, it temporarily replaces liver function, clears toxic substances in the body, compensates for the physiological functions of the liver, and promotes the regeneration of liver cells, which is helpful for liver recovery[3]. For patients with liver cancer who have undergone surgery, the artificial liver support system can temporarily replace the liver, maintain metabolic balance, and reduce the risk of postoperative liver failure; it therefore has high application value[4].

Traditional Chinese medicine (TCM) believes that the pathogenesis of liver cancer is due to insufficient vital qi and the invasion of toxic pathogens into the liver, resulting in qi stagnation and blood stasis. Therefore, during postoperative treatment, strengthening the spleen and replenishing qi, as well as promoting blood circulation and removing blood stasis, are the main principles. TCM agents for strengthening the body and removing blood stasis have the effects of promoting blood circulation and removing blood stasis, warming yang, and replenishing qi, and have shown good results in clinical applications. At present, there are relatively few reports on the effect of the combination of the artificial liver support system and TCM agents on strengthening the body and removing blood stasis in patients with liver cancer, which has certain research value. To analyze this effect, 98 patients were selected for a comparative analysis. The details are presented below.

MATERIALS AND METHODS

General information

A total of 98 patients with liver cancer who underwent surgical treatment in the hospital between January 2023 and January 2024 were selected and divided into two groups using the random lottery method, with 49 patients in each group.

The inclusion criteria were: (1) Those who met the diagnostic criteria for liver cancer in the “Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2022 Edition)”[5]; (2) Patients with stage I-II primary liver cancer; (3) Those who received surgical treatment; and (4) Patients with normal language function and the ability to communicate normally.

The exclusion criteria were: (1) Patients with metastatic liver cancer; (2) Those allergic to the drugs used in this study; (3) Patients participating in other clinical drug trials; (4) Pregnant or lactating women; and (5) Those with severe intellectual disabilities.

The control group had 25 men and 24 women; mean age 57.36 ± 5.69 years, range 44-71 years. According to the Child-Pugh liver function classification, there were 21 grade A and 28 grade B cases. The mean tumor diameter was 6.14 ± 0.88, range: 3-9 cm. The observation group had 26 men and 23 women; mean age 57.40 ± 5.55, range: 43-72 years. According to the Child-Pugh liver function classification, there were 20 cases of grade A and 29 cases of grade B. The mean tumor diameter was 6.12 ± 0.86, range: 3-9 cm. There were no significant differences in the clinical data between the two groups (P > 0.05).

Method

The control group was treated with the artificial liver support system using a combination of plasma exchange (PE) and a dual plasma molecular adsorption system (DPMAS). The equipment used included a continuous blood purification system, a plasma separator model, a plasma bilirubin adsorption device, a blood perfusion device, and an extracorporeal circulation line. Specifically, the PE + DPMAS treatment involved the combined use of plasma bilirubin adsorbents and flow perfusion with sequential PE treatment. The blood flow rate was set at 120-150 mL/minute, the plasma separation rate at 25-33 mL/minute, and the PE volume at 1500 mL (using frozen plasma). Each treatment session lasted 3.5-4.5 hours, with a treatment interval of 2-4 days.

In the observation group, in addition to the artificial liver support system, patients were administered TCM decoctions. The formula included 15 g Astragalus, 15 g Codonopsis, 15 g Salvia miltiorrhiza, 15 g Bupleurum root, 9 g white peony root, 9 g Curcuma, 6 g Imperata cylindrica, and 6 g Schisandra chinensis. The herbs were boiled in water, and the patients were instructed to take one dose per day, divided into two sessions: One warm dose after breakfast and the other after dinner. The formula can be adjusted depending on the individual symptoms. For patients with irritability and insomnia, 9 g Ziziphus spinosa was added. For those with a thick tongue coating, 9 g Citrus reticulata peel was used.

Observational indicators

Gastrointestinal recovery: Including the recovery time of bowel sound recovery, first flatus, and first defecation.

Liver function: Fasting venous blood was collected before and after treatment, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), glutamyl transpeptidase (GTT), and albumin (ALB) levels were measured using enzyme-linked immunosorbent assay.

Tumor marker levels: The evaluation time was the same as that described above. Fasting venous blood was extracted and carcinoembryonic antigen (CEA), thymidine kinase 1 (TK1), alpha-fetoprotein (AFP), and carbohydrate antigen 19-9 (CA19-9) were measured.

Immune function: Fasting venous blood was collected before and after treatment, and CD4+ and CD8+ levels were measured using flow cytometry.

Safety: The occurrence of allergic reactions, bleeding, rashes, and abdominal pain was recorded in both groups.

Statistical analysis

Data were processed using SPSS26.0 software. Measurement data: mean ± SD meet normal distribution, t test; count data rate (%) uses χ² test; P < 0.05, statistically significant difference.

RESULTS

Comparison of the gastrointestinal recovery between the two groups

The observation group showed significantly shorter times for bowel sound recovery, first flatus, and first defecation than the control group. The bowel sound recovery time was 44.69 ± 4.05 hours in the observation group vs 49.87 ± 4.11 hours in the control group (t = 6.284, P < 0.001). The first flatus time was 51.23 ± 5.05 hours in the observation group compared to 61.78 ± 5.11 hours in the control group (t = 10.279, P < 0.001). The first defecation time was 72.05 ± 6.78 hours in the observation group vs 75.52 ± 6.44 hours in the control group (t = 2.598, P = 0.011). These results indicate that the interventions applied in the observation group were effective in accelerating the postoperative recovery of gastrointestinal function (Table 1).

Table 1 Comparison of gastrointestinal recovery between the two groups, mean ± SD.

Group	Cases	Bowel sound recovery time (hours)	First flatus time (hours)	First defecation time (hours)
Observation	49	44.69 ± 4.05	51.23 ± 5.05	72.05 ± 6.78
Control	49	49.87 ± 4.11	61.78 ± 5.11	75.52 ± 6.44
t	-	6.284	10.279	2.598
P value	-	< 0.001	< 0.001	0.011

Comparison of liver function between the two groups

Before treatment, there were no significant differences in the liver function indicators between the two groups (P > 0.05). After treatment, the levels of ALT, AST, TB, and GTT in the observation group were significantly lower than those in the control group, whereas ALB levels were higher (P < 0.05). Specifically, the ALT level in the observation group decreased from 55.14 ± 2.36 U/L to 42.08 ± 2.06 U/L, compared to a decrease from 55.37 ± 2.44 U/L to 45.78 ± 2.11 U/L in the control group (t = 8.783, P < 0.001). The AST level in the observation group decreased from 76.87 ± 5.22 U/L to 43.14 ± 3.06 U/L, while in the control group, it decreased from 76.29 ± 5.40 U/L to 46.78 ± 3.22 U/L (t = 5.736, P < 0.001). The TB level in the observation group decreased from 44.25 ± 2.66 μmol/L to 22.08 ± 2.14 μmol/L, compared to a decrease from 44.26 ± 2.78 μmol/L to 26.55 ± 2.30 μmol/L in the control group (t = 9.960, P < 0.001). The GTT level in the observation group decreased from 182.56 ± 8.58 U/L to 71.55 ± 5.06 U/L, while in the control group, it decreased from 182.43 ± 8.14 U/L to 76.98 ± 5.23 U/L (t = 5.223, P < 0.001). The ALB level in the observation group increased from 29.75 ± 2.55 ng/mL to 37.56 ± 3.05 ng/mL, compared to an increase from 29.34 ± 2.40 ng/mL to 34.66 ± 3.48 ng/mL in the control group (t = 4.387, P < 0.001). These findings suggest that the combined treatment had a more pronounced effect on liver function recovery (Table 2).

Table 2 Comparison of liver function between the two groups, mean ± SD.

Group	Cases	ALT (U/L)		AST (U/L)		TB (μmol/L)		GTT (U/L)		ALB (ng/mL)
		Before	After	Before	After	Before	After	Before	After	Before	After
Observation	49	55.14 ± 2.36	42.08 ± 2.06	76.87 ± 5.22	43.14 ± 3.06	44.25 ± 2.66	22.08 ± 2.14	182.56 ± 8.58	71.55 ± 5.06	29.75 ± 2.55	37.56 ± 3.05
Control	49	55.37 ± 2.44	45.78 ± 2.11	76.29 ± 5.40	46.78 ± 3.22	44.26 ± 2.78	26.55 ± 2.30	182.43 ± 8.14	76.98 ± 5.23	29.34 ± 2.40	34.66 ± 3.48
t	-	0.474	8.783	0.541	5.736	0.018	9.960	0.077	5.223	0.820	4.387
P value	-	0.636	< 0.001	0.590	< 0.001	0.986	< 0.001	0.939	< 0.001	0.414	< 0.001

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TB: Total bilirubin; GTT: Glutamyl transpeptidase; ALB: Albumin.

Comparison of tumor marker levels between the two groups

Before treatment, there were no significant differences in the tumor marker levels between the two groups (P > 0.05). After treatment, the levels of CEA, TK1, AFP, and CA19-9 were significantly lower in the observation group (P < 0.05). Specifically, the CEA level in the observation group decreased from 17.25 ± 1.56 ng/mL to 6.53 ± 0.88 ng/mL, compared to a decrease from 17.43 ± 1.22 ng/mL to 7.26 ± 0.74 ng/mL in the control group (t = 4.444, P < 0.001). The TK1 Level in the observation group decreased from 2.77 ± 0.32 μg/L to 1.61 ± 0.36 μg/L, while in the control group, it decreased from 2.68 ± 0.80 μg/L to 1.89 ± 0.40 μg/L (t = 3.642, P < 0.001). The AFP level in the observation group decreased from 15.44 ± 1.55 ng/mL to 7.58 ± 0.86 ng/mL, compared to a decrease from 15.29 ± 1.40 ng/mL to 8.99 ± 0.87 ng/mL in the control group (t = 8.068, P < 0.001). The CA19-9 Level in the observation group decreased from 46.57 ± 4.05 U/mL to 33.69 ± 3.06 U/mL, while in the control group, it decreased from 46.43 ± 4.22 U/mL to 36.78 ± 3.28 U/mL (t = 4.822, P < 0.001). These results indicated that the combined treatment approach was more effective in reducing tumor marker levels (Table 3).

Table 3 Comparison of tumor marker levels between the two groups, mean ± SD.

Group	Cases	CEA (ng/mL)		TK1 (μg/L)		AFP (ng/mL)		CA19-9 (U/mL)
		Before	After	Before	After	Before	After	Before	After
Observation	49	17.25 ± 1.56	6.53 ± 0.88	2.77 ± 0.32	1.61 ± 0.36	15.44 ± 1.55	7.58 ± 0.86	46.57 ± 4.05	33.69 ± 3.06
Control	49	17.43 ± 1.22	7.26 ± 0.74	2.68 ± 0.80	1.89 ± 0.40	15.29 ± 1.40	8.99 ± 0.87	46.43 ± 4.22	36.78 ± 3.28
t	-	0.636	4.444	0.731	3.642	0.503	8.068	0.168	4.822
P value	-	0.526	< 0.001	0.466	< 0.001	0.616	<0.001	0.867	< 0.001

CEA: Carcinoembryonic antigen; TK1: Thymidine kinase 1; AFP: Alpha-fetoprotein; CA19-9: Carbohydrate antigen 19-9.

Immune function comparison between the two groups

The CD4+ and CD8+ T cell counts were measured before and after treatment in both the observation and control groups. In the observation group, CD4+ T cell counts increased significantly from 25.43% ± 1.66% to 28.98% ± 1.15% (t = 6.913, P < 0.001), while CD8+ T cell counts decreased significantly from 37.56% ± 1.26% to 31.25% ± 1.02% (t = 11.201, P < 0.001). In the control group, CD4+ T cell counts increased from 25.38% ± 1.40% to 27.16% ± 1.44% (t = 6.913, P < 0.001), and CD8+ T cell counts decreased from 37.29% ± 1.33% to 33.77% ± 1.20% (t = 11.201, P < 0.001). These results suggest that treatment had a more significant impact on immune cell counts in the observation group, indicating an improvement in immune function (Table 4).

Table 4 Comparison of immune function between the two groups, mean ± SD.

Group	Cases	CD4+ (%)		CD8+ (%)
		Before	After	Before	After
Observation	49	25.43 ± 1.66	28.98 ± 1.15	37.56 ± 1.26	31.25 ± 1.02
Control	49	25.38 ± 1.40	27.16 ± 1.44	37.29 ± 1.33	33.77 ± 1.20
t	-	0.161	6.913	1.032	11.201
P value	-	0.872	< 0.001	0.305	< 0.001

Safety comparison of the two groups

The incidences of adverse reactions were compared between the observation and control groups. The observation group had 5 cases (10.20%) of adverse reactions, whereas the control group had 2 cases (4.08%). The χ² value was 0.615, and the P value was 0.433, indicating no significant difference between the two groups in the incidence of adverse reactions. This suggested that the intervention did not significantly affect the overall incidence of adverse reactions (Table 5).

Table 5 Comparison of the two groups, n (%).

Group	Cases	Allergic reaction	Bleeding	Rash	Abdominal pain	Total incidence
Observation	49	1 (2.04)	1 (2.04)	1 (2.04)	2 (4.08)	5 (10.20)
Control	49	1 (2.04)	0 (0.00)	0 (0.00)	1 (2.04)	2 (4.08)
χ2	-	-	-	-	-	0.615
P value	-	-	-	-	-	0.433

DISCUSSION

The etiology and pathogenesis of liver cancer remain unclear. Factors such as alcohol consumption and viral hepatitis are believed to be involved. Additionally, smoking and excessive alcohol intake can increase the risk of disease. In TCM, liver cancer falls into the categories of “costal pain” and “abdominal mass”. Patients often experience internal injuries due to emotional stress, with the liver qi rebelling transversely and failing to perform its dredging function properly. This leads to qi stagnation and blood stasis, which damage the spleen. External pathogens invade and attack internal organs, accumulating in the liver and gallbladder. The combination of internal and external pathogens entangles and over time, cancer toxins are generated, resulting in liver cancer development. Surgery, including liver transplantation and resection, is one of the main treatments for liver cancer. In recent years, with the continuous development of medical technology, minimally invasive therapies, such as radiofrequency ablation, have gradually been applied in the treatment of liver cancer. Surgery aims to treat liver cancer by removing the cancerous tissue or cancer cells. However, as surgery is an invasive treatment, it may cause a certain degree of damage to the liver. Therefore, after surgical treatment, patients with liver cancer often require liver support therapies, such as the artificial liver support system.

In recent years, with the continuous development of life sciences and biomedicine, the artificial liver support system has attracted considerable attention and has gradually become one of the main methods for treating liver diseases[6,7]. The artificial liver support system works by drawing blood from the body; through material exchange of catheterization, adsorption, filtration, or cell bioreactors, it replaces the function of the liver, removes toxins from the body, and reinfuses essential substances back into the body, compensating for some of the liver’s physiological functions, promoting the regeneration of liver cells, and enabling the liver to maintain a normal living state[8,9]. The artificial liver support system primarily including PE and DPMAS. PE works by drawing blood out of the body, separating it into plasma and cellular components, discarding the plasma, and replacing the separated plasma with fresh plasma, which is reinfused into the patient's body to remove toxic substances and improve liver function[10,11]. DPMAS is a DPMAS that can perform dual adsorption with a neutral macroporous resin and ion exchange resin, removing inflammatory mediators and inflammatory factors, and effectively reducing bilirubin levels. Combined with PE, it can activate the immune defense, reshape the liver function of the body, and improve the patient's liver function state, achieving certain results in the treatment of patients undergoing surgery for liver cancer and helping with the recovery of liver function after surgery[12,13]. However, the treatment circuit of the artificial liver support system may, to some extent, damage blood cells and affect postoperative recovery[14]. Therefore, other drugs are often used in combination with the artificial liver support system.

This study found that after treatment, the levels of ALT, AST, TB, and GTT in the observation group were lower than those in the control group, and the level of ALB was relatively higher (P < 0.05). This indicates that the combination of the artificial liver support system and TCM agents for strengthening the body and removing blood stasis is conducive to the recovery of liver function in patients with liver cancer after surgery[15,16]. In the agents for strengthening the body and removing blood stasis, Rehmannia glutinosa can nourish blood, nourish yin, and replenish essence and marrow; Astragalus membranaceus can reinforce the exterior, generate yang, invigorate the spleen, and replenish qi; Atractylodes macrocephala can invigorate the spleen, benefit the stomach, dry dampness, and regulate the middle-jiao; Poria cocos can promote diuresis to reduce edema, invigorate the spleen, and calm the mind; Codonopsis pilosula has the effects of tonifying the middle-jiao, replenishing qi, nourishing blood, and promoting fluid production; Salvia miltiorrhiza can remove blood stasis, relieve pain, promote blood circulation, and calm the mind[17]; Imperata cylindrica can clear heat, remove toxins, reduce swelling, and promote diuresis; Bupleurum chinense can elevate yang qi, soothe the liver, and relieve depression; Sparganium stoloniferum can break blood, promote qi circulation, and eliminate stagnation and pain; Paeonia lactiflora can suppress the hyperactivity of liver-yang and soothe the liver to relieve pain; Curcuma phaeocaulis can break blood, promote qi circulation, remove blood stasis, and reduce swelling; Schisandra chinensis can astringe, secure, replenish qi, and promote fluid production; and Glycyrrhiza uralensis can invigorate the spleen and replenish qi[18]. The combined use of these herbs can promote blood circulation to remove blood stasis, warm yang, and replenish qi, which helps improve liver function. In addition, agents that strengthen the body and remove blood stasis can inhibit liver fibrosis. They inhibit the activation of hepatic stellate cells, prevent cell fibrosis, and reconstruct intrahepatic structures. At the same time, they can protect hepatocytes, prevent peroxidative damage, inhibit hepatocyte apoptosis, and suppress the formation of new blood vessels in the liver[19,20]. This not only improves the liver function of patients with liver cancer after surgery but also reduces the recurrence rate of the disease[21]. When combined with the artificial liver support system, it can further improve the liver function in patients with liver cancer after surgery[22].

As a malignant tumor, liver cancer causes abnormal liver function in patients, which indirectly affects the normal operation of the digestive system, leading to abnormal gastrointestinal function[23-25]. Moreover, surgery for liver cancer may affect corresponding organs, such as the digestive function, resulting in a decline in the patient's digestive function and weakened digestive ability. This study found that there were significant differences in the indicators related to gastrointestinal recovery between the two groups of patients (P < 0.05), indicating that the combined treatment is helpful in promoting gastrointestinal recovery in patients with liver cancer after surgery. The artificial liver support system can temporarily restore liver function, thereby reducing the impact of abnormal liver function on the patient’s digestive function[26]. Modern pharmacological studies have found that Atractylodes macrocephala, which strengthens the body and removes blood stasis, has a long-lasting antidiuretic effect, and can bidirectionally regulate the gastrointestinal system, promoting its recovery of the gastrointestinal system. In addition, crude saponins from Bupleurum chinense can inhibit the secretion of gastric juice, reduce protease activity, and decrease ulcer coefficients[27]. At the same time, saikosaponins it contains have an anti-spasmodic effect on the isolated intestinal tract, which regulates gastrointestinal function. When combined with drugs such as Atractylodes macrocephala, it promotes the recovery of gastrointestinal function in patients with liver cancer after surgery.

CEA is expressed in various malignant tumors and is used to diagnose and monitor multiple types of cancer. In patients with liver cancer, there may be an abnormal increase in CEA levels, and changes in CEA levels can be used to diagnose liver cancer and assess the clinical outcomes. TK1 is usually present in cells and an increase in its levels is closely related to cell proliferation and tumor activity. AFP is a hematological indicator used for the diagnosis of liver cancer and can be used to monitor treatment efficacy and predict prognosis[28]. CA19-9 is closely associated with the occurrence and development of liver cancer and is mainly synthesized in the liver. If the liver function is impaired, its levels increase abnormally. Therefore, this study assessed the postoperative recovery of patients with liver cancer by observing the changes in CEA, TK1, AFP, and CA19-9 Levels. The study found that after treatment, the levels of CEA, TK1, AFP, and CA19-9 were lower in the observation group (P < 0.05), and the levels of CD4+ were higher, whereas CD8+ levels were lower in the observation group (P < 0.05). This indicates that the combination of the artificial liver support system and TCM tonifying and resolving stasis agents is beneficial for improving the levels of tumor markers in patients undergoing liver cancer surgery, regulating the immune function of the body, and promoting postoperative recovery[29]. Salvia miltiorrhiza, a component of TCM tonifying and resolving stasis agents, has been found through modern pharmacological research to regulate the microcirculation of the body and inhibit fibroblasts, thereby activating collagenase, maintaining the balance of hormones in the body, regulating the immune function of the body, and providing favorable conditions for the postoperative recovery of patients with liver cancer[12]. Through the combined action of PE and DPMAS, the artificial liver support system temporarily restores liver function, removes toxic substances from the body, improves the levels of tumor markers in patients, and promotes postoperative recovery speed. The data in Table 5 show that there was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05), indicating that the combination of the artificial liver support system and TCM tonifying and resolving stasis agents had a relatively high safety profile.

It should be noted that this study has some limitations. First, the sample size was relatively small, which might have affected the statistical power of the results. Future studies should consider increasing the sample size to enhance the reliability of their findings. Second, the study did not include a long-term follow-up of patients; therefore, the long-term effects of the combined treatment on patients with liver cancer remain unclear. Further studies with longer follow-up periods are required to evaluate the sustained impact of the treatment. Third, the sex distribution of the participants was not balanced, which may have influenced the generalizability of the results. Future studies should aim to recruit a more balanced sex distribution to ensure the applicability of the findings to a broader patient population.

CONCLUSION

This study showed that combining the artificial liver support system with TCM for strengthen the body and remove blood stasis is an effective treatment for postoperative patients with liver cancer. It significantly improves liver and gastrointestinal functions, enhances immune responses, and reduces tumor marker levels with high safety. These results suggest that it could be a promising approach for optimizing postoperative care and improving patient outcomes, potentially reducing complications and enhancing quality of life. Further research is required to determine its long-term benefits.