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Morbidity of hepatic resection for intermediate and advanced hepatocellular carcinoma

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Abstract

Purpose

According to current treatment guidelines, surgical resection of hepatocellular carcinoma (HCC) is mostly restricted to a limited subgroup of patients. Due to improved surgical techniques and perioperative management, liver resections may also be performed more extendedly and also in cirrhotic livers with clinical signs of portal hypertension in selected patients. In this study, the clinical and long-term outcomes of liver resection in HCC patients with or without liver cirrhosis were evaluated.

Methods

One hundred fifty-eight patients undergoing liver resection for primary HCC at our institution were identified. Logistic and Cox regression analyses were used to identify prognostic parameters for postoperative complications and survival.

Results

In our cohort of patients, there was no association between clinical parameters or extent of surgical resection and postoperative morbidity. Only Barcelona Clinic Liver Cancer (BCLC) stage C patients were at significantly higher risk for major complications (OR 5.27, P = 0.009). Risk factors influencing long-term survival were patient age (HR 1.026, P = 0.027) and BCLC stage C (HR 3.47, P = 0.002). Compared to patients without liver cirrhosis, BCLC stage A and B patients undergoing resection were at similar risk for the development of severe complications and long-term mortality.

Conclusion

Liver resection as potentially curative therapy can be performed in selected patients in BCLC stage B, as well as in patients with clinical signs of portal hypertension. The resection of HCC-classified BCLC stage C is feasible but associated with significant morbidity and mortality.

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Author contributions

PR, JS, and SAF had full access to study data and took responsibility for the integrity and accuracy of data analysis. PR, ML, SAL, EKG, HJS, and SAF were responsible for the concept and design of the study. PR, JS, and SAF were responsible for the acquisition of data. PR, JS, AK, FZ, ML, SAL, EKG, HJS, and SAF performed the analysis and interpretation of data. PR, FZ, EKG, HJS, and SAF were responsible in the drafting of the manuscript. AK, ML, SAL, EKG, and HJS conducted the critical revision of the manuscript for important intellectual content. FZ, PR, and JS completed the statistical analysis. .EKG, HJS, SAF were responsible for the study supervision.

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Authors and Affiliations

  1. Department of Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany

    Philipp Renner, Jürgen Schuhbaum, Alexander Kroemer, Martin Loss, Sven A. Lang, Edward K. Geissler, Hans J. Schlitt & Stefan A. Farkas

  2. Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany

    Florian Zeman

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  1. Philipp Renner
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  2. Jürgen Schuhbaum
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  3. Alexander Kroemer
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Corresponding author

Correspondence to Philipp Renner.

Ethics declarations

All authors declare no conflict of interest related to this work. P. Renner receives funding from the German Research Society and Novartis. The retrospective analysis of our study cohort was in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflicts of interest

PR is financially supported by Novartis and the German Research Society (DFG) (not in relation with the manuscript).

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Renner, P., Schuhbaum, J., Kroemer, A. et al. Morbidity of hepatic resection for intermediate and advanced hepatocellular carcinoma. Langenbecks Arch Surg 401, 43–53 (2016). https://doi.org/10.1007/s00423-015-1359-y

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  • DOI: https://doi.org/10.1007/s00423-015-1359-y

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