Xu S, Hao LW, Li X, Zhou XN. Stress response, complications, and postoperative recovery in patients with hepatocellular carcinoma and comorbid anxiety/depression undergoing ultrasound-guided intervention. World J Psychiatry 2025; 15(12): 110858 [PMID: 41357926 DOI: 10.5498/wjp.v15.i12.110858]
Corresponding Author of This Article
Shuang Xu, MD, Department of Medical imaging, Henan Provincial People's Hospital, No. 7 Weiwu Road, Zhengzhou 450000, Henan Province, China. olivia_xs_2025@163.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
Randomized Controlled Trial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Psychiatry. Dec 19, 2025; 15(12): 110858 Published online Dec 19, 2025. doi: 10.5498/wjp.v15.i12.110858
Stress response, complications, and postoperative recovery in patients with hepatocellular carcinoma and comorbid anxiety/depression undergoing ultrasound-guided intervention
Shuang Xu, Liu-Wei Hao, Xia Li, Xiao-Ning Zhou
Shuang Xu, Liu-Wei Hao, Xia Li, Xiao-Ning Zhou, Department of Medical Imaging, Henan Provincial People’s Hospital, Zhengzhou 450000, Henan Province, China
Author contributions: Xu S performed the research and drafted the manuscript; Hao LW, Li X, and Zhou XN analyzed the data; Xu S conceived the research and provided guidance; all authors reviewed and approved the final manuscript submitted for publication.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Henan Provincial People’s Hospital (Approval No. AF/SC-08/05.0).
Clinical trial registration statement: The study was registered at the Clinical Trial Center (www.researchregistry.com) with registration number: Researchregistry11454.
Informed consent statement: All study participants and their legal guardians provided written informed consent before recruitment.
Conflict-of-interest statement: The authors declare no conflicts of interest to declare.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shuang Xu, MD, Department of Medical imaging, Henan Provincial People's Hospital, No. 7 Weiwu Road, Zhengzhou 450000, Henan Province, China. olivia_xs_2025@163.com
Received: July 11, 2025 Revised: August 14, 2025 Accepted: September 23, 2025 Published online: December 19, 2025 Processing time: 139 Days and 0.6 Hours
Abstract
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 (n = 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 (P > 0.05); however, scores in the study group were significantly lower postoperatively (P < 0.05). On postoperative day 1, there were no significant differences in serum levels of CRP, VEGF, or SOD between the groups (P > 0.05), whereas the levels in the intervention group were significantly lower than those in the control group on days 3 and 7 (P < 0.05). The incidence of postoperative complications in the study group (6.66%) was significantly lower than that in the control group [17.78% (P < 0.05)]. The study group also had a significantly shorter time to first flatus, oral intake, and postoperative hospital stay (P < 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 (P < 0.05) but no differences preoperatively (P > 0.05). There was no statistical difference in tumor recurrence rates between the 2 groups during the six-month follow-up (P > 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.
Core Tip: Compared with conventional laparoscopic hepatectomy, ultrasound-guided interventional surgery for small hepatocellular carcinoma effectively improved negative emotions (according to the Hamilton Depression and Anxiety Scales), reduced stress-response markers (e.g., C-reactive protein and vascular endothelial growth factor), decreased complication rates, promoted postoperative recovery, and enhanced quality of life.
