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Post-hepatectomy liver failure after hepatic resection for hepatocellular carcinoma: a single center experience

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Abstract

Purpose

Post-hepatectomy liver failure (PHLF) is one of the most feared morbidities after liver resection (LR) for hepatocellular carcinoma (HCC). We aimed to investigate the incidence and predictors of PHLF after LR for HCC and its impact on survival outcomes.

Methods

We reviewed the patients who underwent LR for HCC during the period between January 2010 and 2019.

Results

Two hundred sixty-eight patients were included. Patients were divided into two groups according to the occurrence of PHLF, defined according to ISGLS. The non-PHLF group included 138 patients (51.5%), while the PHLF group included 130 patients (48.5%). Two hundred forty-six patients (91.8%) had hepatitis C virus. Major liver resections were more performed in the PHLF group (40 patients (30.8%) vs. 18 patients (13%), p = 0.001). Longer operation time (3 vs. 2.5 h, p = 0.001), more blood loss (1000 vs. 500 cc, p = 0.001), and transfusions (81 patients (62.3%) vs. 52 patients (37.7%), p = 0.001) occurred in PHLF group. The 1-, 3-, and 5-year Kaplan-Meier overall survival rates for the non-PHLF group were 93.9%, 79.5%, and 53.9% and 73.2%, 58.7%, and 52.4% for the PHLF group, respectively (log rank, p = 0.003). The 1-, 3-, and 5-year Kaplan-Meier disease-free survival rates for the non-PHLF group were 77.7%, 42.5%, and 29.4%, and 73.3%, 42.9%, and 25.3% for the PHLF group, respectively (log rank, p = 0.925). Preoperative albumin, bilirubin, INR, and liver cirrhosis were significant predictors of PHLF in the logistic regression analysis.

Conclusion

Egyptian patients with HCC experienced higher PHLF incidence after LR for HCC. PHLF significantly affected the long-term survival of those patients.

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References

  1. Ghouri YA, Mian I, Rowe JH (2017) Review of hepatocellular carcinoma: epidemiology, etiology, and carcinogenesis. J Carcinogenesis 16:1

    CAS  Google Scholar 

  2. El-Serag HB (2011) Hepatocellular carcinoma. N Engl J Med 365:1118–1127

    CAS  PubMed  Google Scholar 

  3. Sherman M (2005) Hepatocellular carcinoma: epidemiology, risk factors, and screening. Semin Liver Dis 24:143–154

    Google Scholar 

  4. Waked I, Esmat G, Elsharkawy A, el-Serafy M, Abdel-Razek W, Ghalab R, Elshishiney G, Salah A, Abdel Megid S, Kabil K, el-Sayed MH, Dabbous H, el Shazly Y, Abo Sliman M, Abou Hashem K, Abdel Gawad S, el Nahas N, el Sobky A, el Sonbaty S, el Tabakh H, Emad E, Gemeah H, Hashem A, Hassany M, Hefnawy N, Hemida AN, Khadary A, Labib K, Mahmoud F, Mamoun S, Marei T, Mekky S, Meshref A, Othman A, Ragab O, Ramadan E, Rehan A, Saad T, Saeed R, Sharshar M, Shawky H, Shawky M, Shehata W, Soror H, Taha M, Talha M, Tealaab A, Zein M, Hashish A, Cordie A, Omar Y, Kamal E, Ammar I, AbdAlla M, el Akel W, Doss W, Zaid H (2020) Screening and treatment program to eliminate hepatitis C in Egypt. N Engl J Med 382(12):1166–1174

    PubMed  Google Scholar 

  5. Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma: conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430

    CAS  PubMed  Google Scholar 

  6. Yao FY, Bass NM, Nikolai B (2002) Liver transplantation for hepatocellular carcinoma: analysis of survival according to the intention-to-treat principle and dropout from the waiting list. Liver Transpl 8:873–883

    PubMed  Google Scholar 

  7. Shehta A, Han HS, Yoon YS, Cho JY, Choi Y (2016) Laparoscopic liver resection for hepatocellular carcinoma in cirrhotic patients: 10-year single center experience. Surg Endosc 30(2):638–648

    PubMed  Google Scholar 

  8. Arii S, Yamaoka Y, Futagawa S et al (2000) Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. The Liver Cancer Study Group of Japan. Hepatology 32:1224–1229

    CAS  PubMed  Google Scholar 

  9. Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, Corvera C, Weber S, Blumgart LH (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 236(4):397–407

    PubMed  PubMed Central  Google Scholar 

  10. Fukushima K, Fukumoto T, Kuramitsu K, Kido M, Takebe A, Tanaka M, Itoh T, Ku Y (2014) Assessment of ISGLS definition of posthepatectomy liver failure and its effect on outcome in patients with hepatocellular carcinoma. J Gastrointest Surg 18(4):729–736

    PubMed  Google Scholar 

  11. Kawano Y, Sasaki A, Kai S, Endo Y, Iwaki K, Uchida H, Shibata K, Ohta M, Kitano S (2008) Short and long-term outcome after hepatic resection for hepatocellular carcinoma with concomitant esophageal varices in patients with cirrhosis. Ann Surg Oncol 15:1670–1676

    PubMed  Google Scholar 

  12. Okumura Y, Takeda S, Fujii T et al (2011) Prognostic significance of postoperative complications after hepatectomy for hepatocellular carcinoma. J Surg Oncol 104:814–821

    Google Scholar 

  13. Chok KS, Ng KK, Poon RT, Lo CM, Fan ST (2009) Impact of postoperative complications on long-term outcome of curative resection for hepatocellular carcinoma. Br J Surg 96:81–87

    CAS  PubMed  Google Scholar 

  14. Wolters U, Wolf T, Stutzer H, Schroder T (1996) ASA classification and perioperative variables as predictors of postoperative outcomes. Br J Anaesth 77:217–222

    CAS  PubMed  Google Scholar 

  15. Wahab MA, Shehta A, Hamed H, El Nakeeb A, Salah T (2014) Predictors of recurrence in hepatitis C virus related hepatocellular carcinoma after hepatic resection: a retrospective cohort study. Eurasian J Med 46(1):36–41

    PubMed  PubMed Central  Google Scholar 

  16. Abdel-Wahab M, El-Husseiny TS, El Hanafy E, El Shobary M, Hamdy E (2010) Prognostic factors affecting survival and recurrence after hepatic resection for hepatocellular carcinoma in cirrhotic liver. Langenbeck’s Arch Surg 395(6):625–632

    Google Scholar 

  17. Terminology Committee of the International Hepato-Pancreato- Biliary Association (2000) The IHPBA Brisbane 2000 terminology of liver anatomy and resections. HPB Surg 2:333–339

    Google Scholar 

  18. Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, Koch M, Makuuchi M, Dematteo RP, Christophi C, Banting S, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Yokoyama Y, Fan ST, Nimura Y, Figueras J, Capussotti L, Büchler MW, Weitz J (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149:713–724

    PubMed  Google Scholar 

  19. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    PubMed  PubMed Central  Google Scholar 

  20. Koch M, Garden OJ, Padbury R et al (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149:680–688

    PubMed  Google Scholar 

  21. Rahbari NN, Garden OJ, Padbury R, Maddern G, Koch M, Hugh TJ, Fan ST, Nimura Y, Figueras J, Vauthey JN, Rees M, Adam R, DeMatteo RP, Greig P, Usatoff V, Banting S, Nagino M, Capussotti L, Yokoyama Y, Brooke-Smith M, Crawford M, Christophi C, Makuuchi M, Büchler MW, Weitz J (2011) Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB 13(8):528–535

    PubMed  PubMed Central  Google Scholar 

  22. Frank C, Mohamed MK, Strickland GT, Lavanchy D, Arthur RR, Magder LS, Khoby TE, Abdel-Wahab Y, Ohn ESA, Anwar W, Sallam I (2000) The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt. Lancet 355:887–891

    CAS  PubMed  Google Scholar 

  23. Freeman A, Dore GJ, Law MG et al (2001) Estimating progression to cirrhosis in chronic hepatitis C virus infection. Hepatology 34:809–816

    CAS  PubMed  Google Scholar 

  24. Ziser A, Plevak DJ, Wiesner RH, Rakela J, Offord KP, Brown DL (1999) Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Anesthesiology 90:42–53

    CAS  PubMed  Google Scholar 

  25. Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O (2000) Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 191:38–46

    CAS  PubMed  Google Scholar 

  26. Casaccia M, Andorno E, Domenico SD, Nardi I, Bottino G, Gelli M, Valente U (2011) Laparoscopic liver resection for hepatocellular carcinoma in cirrhotic patients. Feasibility of nonanatomic resection in difficult tumor locations. J Minim Access Surg 7(4):222–226

    PubMed  PubMed Central  Google Scholar 

  27. Farges O, Malassagne B, Flejou JF, Balzan S, Sauvanet A, Belghiti J (1999) Risk of major liver resection in patients with underlying chronic liver disease: a reappraisal. Ann Surg 229:210–215

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Cucchetti A, Ercolani G, Vivarelli M, Cescon M, Ravaioli M, La Barba G (2006) Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis. Liver Transpl 12:966–971

    PubMed  Google Scholar 

  29. Dinant S, de Graaf W, Verwer BJ, Bennink RJ, van Lienden KP, Gouma DJ, van Vliet AK, van Gulik TM (2007) Risk assessment of posthepatectomy liver failure using hepatobiliary scintigraphy and CT volumetry. J Nucl Med 48:685–692

    PubMed  Google Scholar 

  30. Mullen JT, Ribero D, Reddy SK, Donadon M, Zorzi D, Gautam S, Abdalla EK, Curley SA, Capussotti L, Clary BM, Vauthey JN (2007) Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg 204:854–862

    PubMed  Google Scholar 

  31. Elshoubary M, Shehta A, Salah T, Sultan AM, Yassen AM, Abdulrazek M, el-Magd EA, Elghawalby AN, Shiha U, Elmorshedi M, Elsadany M, Abdelkhalek E, Fathy O, Wahab MA (2018) Predictive factors of liver dysfunction after right hemihepatectomy for adult living donor liver transplantation. Transplant Proc 50(4):1114–1122

    CAS  PubMed  Google Scholar 

  32. Taura K, Ikai I, Hatano E, Yasuchika K, Nakajima A, Tada M, Seo S, Machimoto T, Uemoto S (2007) Influence of coexisting cirrhosis on outcomes after partial hepatic resection for hepatocellular carcinoma fulfilling the Milan criteria: an analysis of 293 patients. Surgery 142(5):685–694

    PubMed  Google Scholar 

  33. Poon RTP, Fan ST, Ng IOL, Lo CM, Liu CL, Wong J (2000) Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer 89:500–507

    CAS  PubMed  Google Scholar 

  34. Imamura H, Matsuyama Y, Tanaka E, Ohkubo T, Hasegawa K, Miyagawa S, Sugawara Y, Minagawa M, Takayama T, Kawasaki S, Makuuchi M (2003) Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol 38:200–207

    PubMed  Google Scholar 

  35. Minagawa M, Ikai I, Matsuyama Y, Yamaoka Y, Makuuchi M (2007) Staging of hepatocellular carcinoma—assessment of the Japanese TNM and AICCIUICC TNM systems in a cohort of 13,772 patients in Japan. Ann Surg 245:909–922

    PubMed  PubMed Central  Google Scholar 

  36. Pinto A, Hobeika C, Philis A, Kirzin S, Carrère N, Ghouti L (2019) Synchronous liver metastases and peritoneal carcinomatosis from colorectal cancer: different strategies for curative treatment? Langenbeck’s Arch Surg 404(4):477–488

    Google Scholar 

  37. Lurje G, Bednarsch J, Czigany Z, Amygdalos I, Meister F, Schöning W, Ulmer TF, Foerster M, Dejong C, Neumann UP (2018) Prognostic factors of disease-free and overall survival in patients with hepatocellular carcinoma undergoing partial hepatectomy in curative intent. Langenbeck’s Arch Surg 403(7):851–861

    Google Scholar 

  38. Iguchi K, Hatano E, Yamanaka K, Tanaka S, Taura K, Uemoto S (2014) The impact of posthepatectomy liver failure on the recurrence of hepatocellular carcinoma. World J Surg 38(1):150–158

    PubMed  Google Scholar 

  39. Tilg H, Kaser A, Moschen AR (2006) How to modulate inflammatory cytokines in liver diseases. Liver Int 26:1029–1039

    CAS  PubMed  Google Scholar 

  40. Whittaker S, Marais R, Zhu AX (2010) The role of signaling pathways in the development and treatment of hepatocellular carcinoma. Oncogene 29:4989–5005

    CAS  PubMed  Google Scholar 

  41. Barton JS, Riha GM, Differding JA, Underwood SJ, Curren JL, Sheppard BC, Pommier RF, Orloff SL, Schreiber MA, Billingsley KG (2013) Coagulopathy after a liver resection: is it over diagnosed and over treated? HPB (Oxford) 15(11):865–871

    Google Scholar 

  42. Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F (2005) The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242:824–828

    PubMed  PubMed Central  Google Scholar 

  43. Yang T, Zhang J, Lu JH, Yang GS, Wu MC, Yu WF (2011) Risk factors influencing postoperative outcomes ofmajor hepatic resection of hepatocellular carcinoma for patients with underlying liver diseases. World J Surg 35:2073–2082

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Gehan Street, Mansoura, 35516, Egypt

    Ahmed Shehta, Ahmed Farouk, Amgad Fouad, Ahmed Aboelenin, Ahmed Nabieh Elghawalby, Rami Said, Mohamed Elshobary & Ayman El Nakeeb

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  1. Ahmed Shehta
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  2. Ahmed Farouk
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Contributions

Conception and design of the manuscript: Ahmed Shehta and Ayman Elnakeeb; acquisition of data: Ahmed Farouk and Ahmed Shehta; analysis and interpretation of data: Ahmed Shehta, Ahmed Farouk, and Ayman Elnakeeb; drafting the manuscript: all authors; critical revision of the final version to be published: all authors; approval of the final version to be published: all authors.

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Correspondence to Ahmed Shehta.

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Informed consent prior to the surgical procedure was obtained from all patients.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Shehta, A., Farouk, A., Fouad, A. et al. Post-hepatectomy liver failure after hepatic resection for hepatocellular carcinoma: a single center experience. Langenbecks Arch Surg 406, 87–98 (2021). https://doi.org/10.1007/s00423-020-01956-2

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