Updates in Surgery

, Volume 70, Issue 1, pp 57–66 | Cite as

Impact of surgical complications on the risk of hepatocellular carcinoma recurrence after hepatic resection

  • Riccardo Pravisani
  • Umberto Baccarani
  • Miriam Isola
  • Gianluigi Adani
  • Dario Lorenzin
  • Giovanni Terrosu
  • Andrea Risaliti
Original Article


Surgery-related morbidity has been identified as prognostic risk factor for tumor recurrence for several tumor types, but data regarding hepatocellular carcinoma (HCC) are limited and controversial. The aim of this study was to analyze the impact of surgical complications on the risk of HCC recurrence after hepatic resection (HR). A Retrospective study was conducted on a cohort of patients submitted to HR in a tertiary teaching hospital, between January 2006 and December 2015. 112 patients were submitted to HR during the study period. Cirrhosis was present in 84% of cases, with portal hypertension in 19.6%. The median MELD score was 8 (range 6–15). The median number of lesions per patient was 1 (range 1–5) with a mean diameter of 5.4 ± 3.8 cm. Major HR were performed in 18.2% of cases. Overall post-op morbidity was 48.2% with Clavien–Dindo (CD) severity score ≥3 in 15.2% of cases. The most frequent complications were infected biloma (19.6%) and liver failure (14%). HCC recurred in 48% of patients. At univariate analysis overall post-op complications (HR 2.313, p = 0.003), CD score >2 (HR 2.075, p = 0.047), post-op liver failure (HR 2.990, p = 0.007), post-op iperbilirubinemia (HR 1.151, p = 0.049), post-op bleeding (HR 2.633, p < 0.001) and infected biloma (HR 2.696, p = 0.001) were risk factors for HCC recurrence. At multivariate analysis post-op liver failure (HR 4.081, p < 0.0001) and infected biloma (HR 2.971, p < 0.0001) maintained statistical significance for HCC recurrence. Thus Major surgical complications after HR, especially post-op liver failure and infected biloma are risk factors for HCC recurrence.


Hepatocellular carcinoma Hepatic resection HCC recurrence Postoperative complications Infected biloma Postoperative liver failure 


Compliance with ethical standards

Conflict of interest

None of the Authors has any relevant conflict of interest to declare. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Research involving human participants and/or animals

This article did not require any experiment involving any animal but was based on a retrospective clinical investigation just on human participants.

Informed Consent

Informed consent was obtained form all individual participants in the study.


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Copyright information

© Italian Society of Surgery (SIC) 2017

Authors and Affiliations

  • Riccardo Pravisani
    • 1
  • Umberto Baccarani
    • 1
  • Miriam Isola
    • 2
  • Gianluigi Adani
    • 1
  • Dario Lorenzin
    • 1
  • Giovanni Terrosu
    • 1
  • Andrea Risaliti
    • 1
  1. 1.General Surgery and Transplantation Unit, Department of MedicineUniversity of UdineUdineItaly
  2. 2.Division of Medical Statistic, Department of MedicineUniversity of UdineUdineItaly

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