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Association of Viral Hepatitis Status and Post-hepatectomy Outcomes in the Era of Direct-Acting Antivirals

  • Hepatobiliary Tumors
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Abstract

Background

The role of viral hepatitis status in post-hepatectomy outcomes has yet to be delineated. This large, multicentred contemporary study aimed to evaluate the effect of viral hepatitis status on 30-day post-hepatectomy complications in patients treated for hepatocellular carcinoma (HCC).

Methods

Patients from the National Surgical Quality Improvement Program (NSQIP) database with known viral hepatitis status, who underwent hepatectomy for HCC between 2014 and 2018, were included. Patients were classified as HBV-only, HCV-only, HBV and HCV co-infection (HBV/HCV), or no viral hepatitis (NV). Multivariable models were used to assess outcomes of interest. The primary outcome was any 30-day post-hepatectomy complication. The secondary outcomes were major complications and post-hepatectomy liver failure (PHLF). Subgroup analyses were performed for cirrhotic and noncirrhotic patients.

Results

A total of 3234 patients were included. The 30-day complication rate was 207/663 (31.2%) HBV, 356/1077 (33.1%) HCV, 29/81 (35.8%) HBV/HCV, and 534/1413 (37.8%) NV (p = 0.01). On adjusted analysis, viral hepatitis status was not associated with occurrence of any 30-day post-hepatectomy complications (ref: NV, HBV odds ratio (OR) 0.89 [95% confidence interval (CI): 0.71–1.12]; HCV OR 0.91 [95% CI: 0.75–1.10]; HBV/HCV OR 1.17 [95% CI: 0.71–1.93]). Similar results were found in cirrhotic and noncirrhotic subgroups, and for secondary outcomes: occurrence of any major complications and PHLF.

Conclusions

In patients with HCC managed with resection, viral hepatitis status is not associated with 30-day post-hepatectomy complications, major complications, or PHLF compared with NV. This suggests that clinical decisions and prognostication of 30-day outcomes in this population likely should not be made based on viral hepatitis status.

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Acknowledgement

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Authors and Affiliations

  1. Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Ontario, Canada

    Luckshi Rajendran MD, MEd, Woo Jin Choi MD, Hala Muaddi MD, PhD, Matthew Castelo MD & Gonzalo Sapisochin MD, PhD, MSc

  2. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Woo Jin Choi MD & Matthew Castelo MD

  3. Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada

    Tommy Ivanics MD, MPH, Marco P. A. W. Claasen MD & Gonzalo Sapisochin MD, PhD, MSc

  4. Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA

    Tommy Ivanics MD, MPH

  5. Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden

    Tommy Ivanics MD, MPH

  6. Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada

    Jordan J. Feld MD, MPH

  7. Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands

    Marco P. A. W. Claasen MD

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Contributions

L.R.: conception of the project, literature review, data synthesis, interpretation of results, statistical analysis, and writing of the manuscript. W.C.: conception of the project, data synthesis, interpretation of results, statistical analysis, and writing of the manuscript. H.M.: conception of the project, interpretation of results, statistical analysis, and writing of the manuscript. T.I.: conception of the project, interpretation of results, statistical analysis, and writing of the manuscript. J.J.F.: conception of the project, interpretation of results, statistical analysis, and writing of the manuscript. M.P.A.W.C.: conception of the project, interpretation of results, statistical analysis, and writing of the manuscript. M.C.: data synthesis, interpretation of results, statistical analysis, and writing of the manuscript. G.S.: conception of the project, literature review, interpretation of results, statistical analysis, and writing of the manuscript.

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Correspondence to Gonzalo Sapisochin MD, PhD, MSc.

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DISCLOSURES

Gonzalo Sapisochin discloses consultancy for Astra-Zeneca, Roche, Novartis, and Integra. Gonzalo Sapisochin has received financial compensation for talks for Roche, Astra-Zeneca, Chiesi, Evidera and Integra. Gonzalo Sapisochin has received a grant from Roche. Jordan Feld discloses research support from Abbvie, Gilead, GSK, Janssen, Eiger, Enanta, and Roche and consulting for Abbvie, GSK, Gilead, Roche. None of the other authors have any conflicts of interest to declare.

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Disclaimer: The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in this program are the sources of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Rajendran, L., Choi, W.J., Muaddi, H. et al. Association of Viral Hepatitis Status and Post-hepatectomy Outcomes in the Era of Direct-Acting Antivirals. Ann Surg Oncol 30, 2793–2802 (2023). https://doi.org/10.1245/s10434-022-12937-8

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