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Complications after Hepatectomy for Hepatocellular Carcinoma Independently Shorten Survival: A Western, Single-Center Audit

  • Hepatobiliary Tumors
  • Published:
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Abstract

Background

The impact of postoperative complications (POCs) on long-term outcomes following hepatocellular carcinoma (HCC) resection remains to be ascertained.

Methods

All consecutive HCC resected at a single center were analyzed. Patients with POCs, classified according to Clavien classification, were compared to those without in terms of demographics, pathology, management, overall survival (OS), and disease-free survival (DFS). Independent prognostic factors of POCs were identified using multivariable regression models.

Results

Among 341 patients, overall POCs rate was 34% (n = 116) and grade III–IV POCs rate was 14.4% (n = 49). POCs were an independent negative factor for OS [hazard ratio (HR) 1.40, 95% confidence interval (CI) 1.12–2.26, p = 0.009] with BCLC stage, the need for combined procedure, intraoperative transfusion, and the METAVIR score of the underlying parenchyma. Similarly, occurrence of POCs was associated independently with DFS (HR 1.59, 95% CI 1.18–2.15, p = 0.002), together with the presence of portal hypertension, BCLC stage, the need for combined procedure, intraoperative transfusion, and the presence of satellite nodules. After stratification, the negative impact of morbidity on OS and DFS reached statistical significance in the BCLC stage A subset only (p = 0.026, and p < 0.001, respectively). Open resection, intraoperative transfusion, and the existence of underlying liver injury were independent predictors of POCs.

Conclusions

POCs should be considered as a long-term prognostic factor. Careful patient selection requiring underlying liver assessment and appropriate strategy, such as mini-invasive surgery and restricted transfusion policy, might be promoted to prevent POCs.

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    Authors and Affiliations

    1. Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, AP-HP, Créteil, France

      Alexandre Doussot MD, Chetana Lim MD, Eylon Lahat MD, Chady Salloum MD, Michael Osseis MD, Concepción Gómez Gavara MD, Philippe Compagnon MD, PhD & Daniel Azoulay MD, PhD

    2. Department of Anesthesiology and Intensive Care, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, AP-HP, Créteil, France

      Eric Levesque MD

    3. Department of Hepatology, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, AP-HP, Créteil, France

      Cyrille Feray MD, PhD

    4. INSERM 955, Créteil, France

      Philippe Compagnon MD, PhD & Daniel Azoulay MD, PhD

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    Correspondence to Daniel Azoulay MD, PhD.

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    Alexandre Doussot and Chetana Lim have contributed equally to this work and are co-first author.

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    Doussot, A., Lim, C., Lahat, E. et al. Complications after Hepatectomy for Hepatocellular Carcinoma Independently Shorten Survival: A Western, Single-Center Audit. Ann Surg Oncol 24, 1569–1578 (2017). https://doi.org/10.1245/s10434-016-5746-6

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    • DOI: https://doi.org/10.1245/s10434-016-5746-6

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