World Journal of Surgery

, Volume 28, Issue 3, pp 258–262

Deterioration of Hepatic Functional Reserve in Patients with Hepatocellular Carcinoma after Resection: Incidence, Risk Factors, and Association with Intrahepatic Tumor Recurrence

  • Teh-Ia Huo
  • Wing-Yu Lui
  • Jaw-Ching Wu
  • Yi-Hsiang Huang
  • Kuang-Liang King
  • Che-Chuan Loong
  • Pui-Ching Lee
  • Full-Young Chang
  • Shou-Dong Lee
Original Scientific Reports


Hepatocellular carcinoma (HCC) is frequently associated with liver cirrhosis. Patients with HCCs undergoing surgical resection may have declining hepatic functional reserve over time. However, the incidence and risk factors of hepatic decompensation, and its relation to postoperative tumor recurrence are unknown. This study investigated 241 HCC patients (208 male; age 61 ± 13 years) undergoing resection with a long-term follow-up. The Child-Pugh scoring system was used to evaluate the postoperative deterioration of liver reserve, defined as a sustained increment in the Child-Pugh score by 2 or more. The 1-, 3-, and 5-year cumulative probabilities of postoperative decompensation were 14%, 32%, and 56%, respectively, during a follow-up period of 27 ± 18 months (range 3-75 months). The average increment in Child-Pugh score was 1.4 ± 1.1 in 2.3 ± 1.5 years, or 0.6 point per year. Altogether, 74 (31%) patients developed postoperative hepatic decompensation during the follow-up period, 43 (58%) of whom had decompensation within 2 years of resection. Large (> 3 cm) tumor size was the only independent predictor associated with hepatic decompensation (relative risk 1.7, 95% confidence interval 1.1–2.8, p = 0.041) and was a significant risk factor for intrahepatic tumor recurrence (p = 0.018). Patients with tumor recurrence more frequently (40% of 109 patients vs. 23% of 132 patients, p = 0.005) and more rapidly (0.8 vs. 0.4 point per year) developed hepatic decompensation than those without recurrence. In conclusion, large HCCs are closely associated with hepatic decompensation in patients after resection. Tumor recurrence may predispose to the development of hepatic decompensation in these patients.


  1. 1.
    Okuda, K 1992Hepatocellular carcinoma: recent progressHepatology15948963PubMedGoogle Scholar
  2. 2.
    Hussain, SA, Ferry, DR, El-Gazzaz, G,  et al. 2001Hepatocellular carcinomaAnn. Oncol.12161172CrossRefPubMedGoogle Scholar
  3. 3.
    Bosch, FX, Ribes, J, Borras, J 1999Epidemiology of primary liver cancerSemin. Liver Dis.19271285PubMedGoogle Scholar
  4. 4.
    Kawasaki, S, Makuuchi, M, Miyagawa, S,  et al. 1995Results of hepatic resection for hepatocellular carcinomaWorld J. Surg.193134PubMedGoogle Scholar
  5. 5.
    Shirabe, K, Kanematsu, T, Matsumata, T,  et al. 1991Factors linked to early recurrence of small hepatocellular carcinoma after hepatectomy: univariate and multivariate analysisHepatology14802805PubMedGoogle Scholar
  6. 6.
    Jwo, SC, Chiu, JH, Chau, GY,  et al. 1992Risk factors linked to tumor recurrence of human hepatocellular carcinoma after hepatic resectionHepatology1613671371PubMedGoogle Scholar
  7. 7.
    Nagasue, N, Uchida, M, Makino, Y,  et al. 1993Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinomaGastroenterology105488494PubMedGoogle Scholar
  8. 8.
    Izumi, R, Shimizu, K, Ii, T,  et al. 1994Prognostic factors of hepatocellular carcinoma in patients undergoing hepatic resectionGastroenterology106720727PubMedGoogle Scholar
  9. 9.
    Kubo, S, Hirohashi, K, Tanaka, H,  et al. 2000Risk factors for recurrence after resection of hepatitis C virus-related hepatocellular carcinomaWorld J. Surg.2415591565CrossRefGoogle Scholar
  10. 10.
    Lui, WY, Chau, GY, Loong, CC,  et al. 1995Hepatic segmentectomy for curative resection of primary hepatocellular carcinomaArch. Surg.13010901097PubMedGoogle Scholar
  11. 11.
    Nagasue, N, Ono, T, Yamanoi, A,  et al. 2001Prognostic factors and survival after hepatic resection for hepatocellular carcinoma without cirrhosisBr. J. Surg.88515522CrossRefPubMedGoogle Scholar
  12. 12.
    Chen, JY, Chau, GY, Lui, WY,  et al. 2003Clinicopathologic features and factors related to survival of patients with small hepatocellular carcinoma after hepatic resectionWorld J. Surg.27294298CrossRefPubMedGoogle Scholar
  13. 13.
    Haydon, GH, Hayes, PC 1996Screening for hepatocellular carcinomaEur. J. Gastroenterol. Hepatol.8856860PubMedGoogle Scholar
  14. 14.
    Reid, AE, Koziel, MJ, Aiza, I,  et al. 1999Hepatitis C virus genotypes and viremia and hepatocellular carcinoma in the United StatesAm. J. Gastroenterol.9416191626CrossRefPubMedGoogle Scholar
  15. 15.
    Chen, MF, Jeng, LB, Lee, WC 2002Surgical results in patients with hepatitis virus-related hepatocellular carcinoma in TaiwanWorld J. Surg.26742747CrossRefPubMedGoogle Scholar
  16. 16.
    Pugh, RNH, Murray-Lyon, IM, Dawson, JL,  et al. 1973Transection of the esophagus for bleeding oesophageal varicesBr. J. Surg.60646649PubMedGoogle Scholar
  17. 17.
    Bruix, J, Sherman, M, Llovet, JM,  et al. 2001Clinical management of hepatocellular carcinoma: conclusions of the Barcelona-2000 EASL conferenceJ. Hepatol.35421430CrossRefPubMedGoogle Scholar
  18. 18.
    Edmonson, HA, Steiner, PE 1954Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsiesCancer7462503PubMedGoogle Scholar
  19. 19.
    Huang, YH, Wu, JC, Chau, GY,  et al. 1998Detection of serum hepatitis B, C, and D viral nucleic acids and its implications in hepatocellular carcinoma patientsJ. Gastroenterol.33512516CrossRefPubMedGoogle Scholar
  20. 20.
    Tsai, TJ, Chau, GY, Lui, WY,  et al. 2000Clinical significance of microscopic tumor venous invasion in patients with resectable hepatocellular carcinomaSurgery127603608CrossRefPubMedGoogle Scholar
  21. 21.
    Kotoh, K, Sakai, H, Sakamoto, S,  et al. 1994The effect of percutaneous ethanol injection therapy on small solitary hepatocellular carcinoma is comparable to that of hepatectomyAm. J. Gastroenterol.89194198PubMedGoogle Scholar
  22. 22.
    Kirchhoff, T, Chavan, A, Galanski, M 1998Transarterial chemoembolization and percutaneous ethanol injection therapy in patients with hepatocellular carcinomaEur. J. Gastroenterol. Hepatol.10907909PubMedGoogle Scholar
  23. 23.
    Ohto, M, Yoshikawa, M, Saisho, H,  et al. 1995Nonsurgical treatment of hepatocellular carcinoma in cirrhotic patientsWorld J. Surg.194246PubMedGoogle Scholar
  24. 24.
    Huo, TI, Huang, YH, Wu, JC,  et al. 2003Comparison of percutaneous acetic acid injection and percutaneous ethanol injection for hepatocellular carcinoma in cirrhotic patients: a prospective controlled studyScand. J. Gastroenterol.38770778CrossRefPubMedGoogle Scholar
  25. 25.
    Simonetti, RG, Liberati, A, Angiolini, C,  et al. 1997Treatment of hepatocellular carcinoma: a systematic review of randomized controlled trialsAnn. Oncol.8117136CrossRefPubMedGoogle Scholar
  26. 26.
    Shijo, H, Okazaki, M, Higashihara, H,  et al. 1992Hepatocellular carcinoma: a multivariate analysis of prognostic features in patients treated with hepatic arterial embolizationAm. J. Gastroenterol.8711541159PubMedGoogle Scholar
  27. 27.
    Rizzi, PM, Kane, PA, Ryder, SD,  et al. 1994Accuracy of radiology in detection of hepatocellular carcinoma before liver transplantationGastroenterology10714251429PubMedGoogle Scholar
  28. 28.
    Utsunomiya, T, Matsumata, T, Adachi, E,  et al. 1992Limitations of current preoperative liver imaging techniques for intrahepatic metastatic nodules of hepatocellular carcinomaHepatology16694701PubMedGoogle Scholar
  29. 29.
    Shuto, T, Hirohashi, K, Ikebe, T,  et al. 2000Additional hepatocellular carcinomas undetectable before surgeryWorld J. Surg.2415661569CrossRefGoogle Scholar
  30. 30.
    Neeleman, N, Andersson, R 1996Repeated liver resection for recurrent liver cancerBr. J. Surg.83893901PubMedGoogle Scholar
  31. 31.
    Hu, RH, Lee, PH, Yu, SC,  et al. 1996Surgical resection for recurrent hepatocellular carcinoma: prognosis and analysis of risk factorsSurgery1202329PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2004

Authors and Affiliations

  • Teh-Ia Huo
    • 1
  • Wing-Yu Lui
    • 2
  • Jaw-Ching Wu
    • 1
  • Yi-Hsiang Huang
    • 1
  • Kuang-Liang King
    • 2
  • Che-Chuan Loong
    • 2
  • Pui-Ching Lee
    • 1
  • Full-Young Chang
    • 1
  • Shou-Dong Lee
    • 1
  1. 1.Division of Gastroenterology, Department of Medicine, National Yang-Ming University School of MedicineTaipei Veterans General HospitalTaipeiTaiwan
  2. 2.Department of Surgery, National Yang-Ming University School of MedicineTaipei Veterans General HospitalTaipeiTaiwan

Personalised recommendations