Predictors and prognostic significance of operative complications in patients with hepatocellular carcinoma who underwent hepatic resection

Kusano, T.; Sasaki, A.; Kai, S.; Endo, Y.; Iwaki, K.; Shibata, K.; Ohta, M.; Kitano, S.

doi:10.1016/j.ejso.2009.04.008

« Previous Next »European Journal of Surgical Oncology
Volume 35, Issue 11 , Pages 1179-1185, November 2009

Predictors and prognostic significance of operative complications in patients with hepatocellular carcinoma who underwent hepatic resection

T. Kusano
- Department of Surgery, National Hospital Organization Miyazaki Hospital, Miyazaki 889-1301, Japan
- Department of Surgery I, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan
A. Sasaki
- Department of Surgery, National Hospital Organization Miyazaki Hospital, Miyazaki 889-1301, Japan
- Department of Surgery I, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan
- Corresponding author. Department of Surgery I, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita 879-5593, Japan. Tel.: +81 97 586 5843; fax: +81 97 549 6039.
S. Kai
- Department of Surgery I, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan
Y. Endo
- Department of Surgery I, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan
K. Iwaki
- Department of Surgery I, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan
K. Shibata
- Department of Surgery I, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan
M. Ohta
- Department of Surgery I, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan
S. Kitano
- Department of Surgery I, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan

Accepted 9 April 2009.

Abstract

Aims

The morbidity rate of hepatic resection for hepatocellular carcinoma (HCC) remains high. To clarify predictors and the prognostic significance of operative complications in patients with HCC, we conducted a comparative retrospective analysis of 291 patients with HCC who underwent hepatic resection.

Methods

Operative complications included hyperbilirubinemia, ascites, hemorrhage, respiratory and cardiovascular diseases, bile leakage and abscess formation, renal failure, wound infection, and pleural effusion. Predictors of operative complications and their prognostic value for long-term survival were studied by univariate and multivariate analyses.

Results

Mortality and morbidity rates were 7.2% and 42.6%. The main operative complications were ascites (n=30), intraabdominal abscess (n=25), hyperbilirubinemia (n=19), wound infection (n=16), pleural effusion (n=10) and intraabdominal hemorrhage (n=9). By a multivariate logistic regression model, Child–Pugh class B and increased operative blood loss (≥1200ml) were independent predictors of postoperative complications. Among 243 patients without operative death, the 5-year overall survival rate was significantly lower in patients with operative complications (34.3%) than in those without these complications (48.7%). By the multivariate Cox proportional hazards model, the presence of operative complications was an independent predictor of poor overall survival as well as presence of portal invasion.

Conclusions

Child–Pugh class B and operative blood loss ≥1200ml were independent predictors of complications after hepatic resection for HCC. Long-term survival is poorer in patients with postoperative complications. Decreasing operative blood loss may result in fewer postoperative complications and better long-term survival of HCC patients.

Keywords: Hepatocellular carcinoma, Hepatic resection, Morbidity, Complications, Prognosis