World Journal of Surgery

, Volume 37, Issue 6, pp 1379–1387 | Cite as

Prognosis and Predictors of Surgical Complications in Hepatocellular Carcinoma Patients With or Without Cirrhosis after Hepatectomy

  • Toru MizuguchiEmail author
  • Masaki Kawamoto
  • Makoto Meguro
  • Yukio Nakamura
  • Shigenori Ota
  • Thomas T. Hui
  • Koichi Hirata



Although poor liver function is associated with a high morbidity rate and poor prognosis in hepatocellular carcinoma (HCC) patients, the exact effects of liver pathology on the surgical outcomes of HCC patients are poorly understood. The purpose of this study was to assess how the liver pathology of HCC patients affects their prognosis and complications rate after liver resection.


Between January 2006 and November 2010, 149 consecutive hepatocellular carcinoma patients, including 79 noncirrhosis patients and 70 cirrhosis patients, were enrolled in this study.


Among the noncirrhotic patients, operative time, fresh frozen plasma (FFP) transfusion requirement, tumor size, and serum retinol binding protein (RBP) levels were significantly higher in the complications group than in the complications-free groups. On the other hand, in the cirrhotic patients the prothrombin time (PT) and indocyanine green retention value at 15 min (ICGR15) of the complications group were significantly lower and higher, respectively, than those of the complications-free group. In the noncirrhotic patients, recurrence-free survival and overall survival did not differ between the complications and complications-free groups. On the other hand, in the cirrhotic patients, the recurrence-free survival and overall survival of the complications-free group were significantly longer than those of the complications group.


In the noncirrhotic patients, surgical complications had no prognostic effect, whereas they had a significant survival impact in the cirrhotic patients. The surgical strategy for HCC should be based on the patient’s pathological background.


Liver Resection Cirrhotic Patient Fresh Freeze Plasma Retinol Binding Protein Pugh Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank Daniel Mrozek (Medical English Service, Kyoto, Japan) for his help preparing this manuscript. Part of this study was supported by a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology (No. 23591993) and a Grant from the Yuasa Memorial Foundation to T. Mizuguchi.

Conflict of interest



  1. 1.
    Forner A, Llovet JM, Bruix J (2012) Hepatocellular carcinoma. Lancet 379:1245–1255PubMedCrossRefGoogle Scholar
  2. 2.
    El-Serag HB (2012) Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology 142:1264–1273PubMedCrossRefGoogle Scholar
  3. 3.
    Vauthey JN, Dixon E, Abdalla EK et al (2010) Pretreatment assessment of hepatocellular carcinoma: expert consensus statement. HPB (Oxford) 12:289–299Google Scholar
  4. 4.
    Chow PK (2012) Resection for hepatocellular carcinoma: is it justifiable to restrict this to the American Association for the Study of the Liver/Barcelona Clinic for Liver Cancer criteria? J Gastroenterol Hepatol 27:452–457PubMedCrossRefGoogle Scholar
  5. 5.
    Starley BQ, Calcagno CJ, Harrison SA (2010) Nonalcoholic fatty liver disease and hepatocellular carcinoma: a weighty connection. Hepatology 51:1820–1832PubMedCrossRefGoogle Scholar
  6. 6.
    Reddy SK, Steel JL, Chen HW et al (2012) Outcomes of curative treatment for hepatocellular cancer in nonalcoholic steatohepatitis versus hepatitis C and alcoholic liver disease. Hepatology 55:1809–1819PubMedCrossRefGoogle Scholar
  7. 7.
    Mizuguchi T, Katsuramaki T, Nobuoka T et al (2004) Serum hyaluronate level for predicting subclinical liver dysfunction after hepatectomy. World J Surg 28:971–976. doi: 10.1007/s00268-004-7389-1 PubMedCrossRefGoogle Scholar
  8. 8.
    Takayama T (2011) Surgical treatment for hepatocellular carcinoma. Jpn J Clin Oncol 41:447–454PubMedCrossRefGoogle Scholar
  9. 9.
    Rahbari NN, Mehrabi A, Mollberg NM et al (2011) Hepatocellular carcinoma: current management and perspectives for the future. Ann Surg 253:453–469PubMedCrossRefGoogle Scholar
  10. 10.
    Bryant R, Laurent A, Tayar C et al (2009) Laparoscopic liver resection-understanding its role in current practice: the Henri Mondor Hospital experience. Ann Surg 250:103–111PubMedCrossRefGoogle Scholar
  11. 11.
    Reddy SK, Tsung A, Geller DA (2011) Laparoscopic liver resection. World J Surg 35:1478–1486. doi: 10.1007/s00268-010-0906-5 PubMedCrossRefGoogle Scholar
  12. 12.
    Koniaris LG, Levi DM, Pedroso FE et al (2011) Is surgical resection superior to transplantation in the treatment of hepatocellular carcinoma? Ann Surg 254:527–537PubMedCrossRefGoogle Scholar
  13. 13.
    Chok KS, Ng KK, Poon RT et al (2009) Impact of postoperative complications on long-term outcome of curative resection for hepatocellular carcinoma. Br J Surg 96:81–87PubMedCrossRefGoogle Scholar
  14. 14.
    Mizuguchi T, Nagayama M, Meguro M et al (2009) Prognostic impact of surgical complications and preoperative serum hepatocyte growth factor in hepatocellular carcinoma patients after initial hepatectomy. J Gastrointest Surg 13:325–333PubMedCrossRefGoogle Scholar
  15. 15.
    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 240:205–213PubMedCrossRefGoogle Scholar
  16. 16.
    Kamath PS, Wiesner RH, Malinchoc M et al (2001) A model to predict survival in patients with end-stage liver disease. Hepatology 33:464–470PubMedCrossRefGoogle Scholar
  17. 17.
    Pugh RN, Murray-Lyon IM, Dawson JL et al (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649PubMedCrossRefGoogle Scholar
  18. 18.
    Benzoni E, Cojutti A, Lorenzin D et al (2007) Liver resective surgery: a multivariate analysis of postoperative outcome and complication. Langenbecks Arch Surg 392:45–54PubMedCrossRefGoogle Scholar
  19. 19.
    Yang T, Zhang J, Lu JH et al (2011) Risk factors influencing postoperative outcomes of major hepatic resection of hepatocellular carcinoma for patients with underlying liver diseases. World J Surg 35:2073–2082. doi: 10.1007/s00268-011-1161-0 PubMedCrossRefGoogle Scholar
  20. 20.
    Okamura Y, Takeda S, Fujii T et al (2011) Prognostic significance of postoperative complications after hepatectomy for hepatocellular carcinoma. J Surg Oncol 104:814–821PubMedCrossRefGoogle Scholar
  21. 21.
    Young AL, Adair R, Prasad KR et al (2012) Hepatocellular carcinoma within a noncirrhotic, nonfibrotic, seronegative liver: surgical approaches and outcomes. J Am Coll Surg 214:174–183PubMedCrossRefGoogle Scholar
  22. 22.
    Belli G, Fantini C, D’Agostino A et al (2004) Laparoscopic liver resections for hepatocellular carcinoma (HCC) in cirrhotic patients. HPB (Oxford) 6:236–246CrossRefGoogle Scholar
  23. 23.
    Schneider PD (2004) Preoperative assessment of liver function. Surg Clin North Am 84:355–373PubMedCrossRefGoogle Scholar
  24. 24.
    Hasegawa K, Kokudo N (2009) Surgical treatment of hepatocellular carcinoma. Surg Today 39:833–843PubMedCrossRefGoogle Scholar
  25. 25.
    Manizate F, Hiotis SP, Labow D et al (2010) Liver functional reserve estimation: state of the art and relevance to local treatments. Oncology 78(Suppl 1):131–134PubMedCrossRefGoogle Scholar
  26. 26.
    Mizuguchi T, Kawamoto M, Meguro M et al (2012) Serum antithrombin III level is well correlated with multiple indicators for assessment of liver function and diagnostic accuracy for predicting postoperative liver failure in hepatocellular carcinoma patients. Hepatogastroenterology 59:551–557PubMedGoogle Scholar
  27. 27.
    Goodman DS (1980) Plasma retinol-binding protein. Ann NY Acad Sci 348:378–390PubMedCrossRefGoogle Scholar
  28. 28.
    Truant S, Boleslawski E, Duhamel A et al (2012) Tumor size of hepatocellular carcinoma in noncirrhotic liver: a controversial predictive factor for outcome after resection. Eur J Surg Oncol 38:1189–1196PubMedCrossRefGoogle Scholar
  29. 29.
    Cucchetti A, Ercolani G, Vivarelli M et al (2006) Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis. Liver Transpl 12:966–971PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Toru Mizuguchi
    • 1
    Email author
  • Masaki Kawamoto
    • 1
  • Makoto Meguro
    • 1
  • Yukio Nakamura
    • 1
  • Shigenori Ota
    • 1
  • Thomas T. Hui
    • 2
  • Koichi Hirata
    • 1
  1. 1.Department of Surgery I, Sapporo Medical University HospitalSapporo Medical University School of MedicineSapporoJapan
  2. 2.Department of SurgeryChildren’s Hospital & Research Center OaklandOaklandUSA

Personalised recommendations