Skip to main content
SpringerLink
Log in

Outcomes in Patients with Chronic Kidney Disease After Liver Resection for Hepatocellular Carcinoma

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to clarify the feasibility of liver resection in hepatocellular carcinoma (HCC) patients with chronic kidney disease (CKD).

Methods

In all, 204 patients who underwent primary liver resection for HCC between 2011 and 2019 were analyzed. Short-term and long-term outcomes were compared between the CKD and control groups. The CKD group was defined by a preoperative estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73 m2 and chronic kidney disease Stage 3B or higher.

Results

Twenty-eight patients (13.7%) had CKD. No significant differences were observed in the overall complication rates between the groups (46.4% vs. 34.7% p = 0.229). The incidence of bile leakage was significantly higher in the CKD group than in the control group (14.3% vs. 4.0% p = 0.048), and the median postoperative hospital stay was significantly longer in the CKD group (11 vs. 9 days p = 0.031). No significant differences were found in the disease-free survival between the two groups (p = 0.763), but overall survival (OS) was significantly worse in the CKD group than in the control group (p = 0.022). In the multivariable analysis, a CKD diagnosis (hazard ratio, 2.261; 95% confidence interval (CI), 1.139–4.486 p = 0.020) was identified as an independent poor prognostic factor for OS. The percentage of patients who died from cardiovascular disease was significantly higher in the CKD group (27.3% vs. 2.3% p = 0.023).

Conclusions

Liver resection for HCC in CKD patients is associated with acceptable perioperative outcomes. However, cardiovascular disease may negatively affect the OS of CKD patients after liver resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Levey AS, Atkins R, Coresh J et al (2007) Chronic kidney disease as a global public health problem: approaches and initiatives-a position statement from kidney disease improving global outcomes. Kidney Int 72:247–259

    Article  CAS  Google Scholar 

  2. Stenvinkel P (2010) Chronic kidney disease: a public health priority and harbinger of premature cardiovascular disease. J Intern Med 268:456–467

    Article  CAS  Google Scholar 

  3. National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–266

  4. Hallan SI, Dahl K, Oien CM et al (2006) Screening strategies for chronic kidney disease in the general population: follow-up of cross sectional health survey. BMJ 333:1047

    Article  Google Scholar 

  5. Coresh J, Selvin E, Stevens LA et al (2007) Prevalence of chronic kidney disease in the United States. JAMA 298:2038–2047

    Article  CAS  Google Scholar 

  6. Campbell KH, O’Hare AM (2008) Kidney disease in the elderly: update on recent literature. Curr Opin Nephrol Hypertens 17:298–303

    Article  Google Scholar 

  7. Zhang QL, Rothenbacher D (2008) Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health 8:117

    Article  Google Scholar 

  8. GoChertowFan AS1GMD et al (2004) Chronic kidney disease and the risks of death, cardiovascular diseases, and hospitalization. N Engl J Med 351:1296–1305

    Article  Google Scholar 

  9. Perlman RL, Finkelstein FO, Liu L et al (2005) Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the renal research institute-CKD study. Am J Kidney Dis 45:658–666

    Article  Google Scholar 

  10. Khan SS, Kazmi WH, Abichandani R et al (2002) Health care utilization among patients with chronic kidney disease. Kidney Int 62:229–236

    Article  Google Scholar 

  11. Shirata C, Hasegawa K, Kokudo T et al (2018) Liver resection for hepatocellular carcinoma in patients with renal dysfunction. World J Surg 42:4054–4062

    Article  Google Scholar 

  12. Orii T, Takayama T, Haga I et al (2008) Efficacy of a liver resection for hepatocellular carcinoma in patients with chronic renal failure. Surg Today 38:329–334

    Article  Google Scholar 

  13. Toshima T, Shirabe K, Yoshiya S et al (2012) Outcome of liver resection for hepatocellular carcinoma in patients with renal dysfunction. HPB (Oxford) 14:317–324

    Article  Google Scholar 

  14. Kaibori M, Matsui Y, Kwon AH et al (2005) Prognosis of hepatocellular carcinoma after liver resection in patients with renal dysfunction. World J Surg 29:375–381

    Article  Google Scholar 

  15. Inker LA, Astor BC, Fox CH et al (2014) KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis 63:713–735

    Article  Google Scholar 

  16. Stengel B, Metzger M, Froissart M et al (2011) Epidemiology and prognostic significance of chronic kidney disease in the elderly–the three-city prospective cohort study. Nephrol Dial Transplant 26:3286–3295

    Article  Google Scholar 

  17. Raymond NT, Zehnder D, Smith SC et al (2007) Elevated relative mortality risk with mild-to-moderate chronic kidney disease decreases with age. Nephrol Dial Transplant 22:3214–3220

    Article  Google Scholar 

  18. Muntner P, Bowling CB, Gao L et al (2011) Age-specific association of reduced estimated glomerular filtration rate and albuminuria with all-cause mortality. Clin J Am Soc Nephrol 6:2200–2207

    Article  CAS  Google Scholar 

  19. Oh SW, Kim S, Na KY et al (2014) Glomerular filtration rate and proteinuria: association with mortality and renal progression in a prospective cohort of a community-based elderly population. PLoS ONE 9:e94120

    Article  Google Scholar 

  20. Ferrero A, Russolillo N, Vigano L et al (2008) Safety of conservative management of bile leakage after liver resection with biliary reconstruction. J Gastrointest Surg 12:2204–2211

    Article  Google Scholar 

  21. Brooke-Smith M, Figueras J, Ullah S et al (2015) Prospective evaluation of the international study group for liver surgery definition of bile leak after a liver resection and the role of routine operative drainage: an international multicentre study. HPB (Oxford) 17:46–51

    Article  Google Scholar 

  22. Panaro F, Hacina L, Bouyabrine H et al (2016) Risk factors for postoperative bile leakage: a retrospective single-center analysis of 411 hepatectomies. Hepatobiliary Pancreat Dis Int 15:81–86

    Article  Google Scholar 

  23. Rahbari NN, Elbers H, Koch M et al (2012) Bilirubin level in the drainage fluid is an early and independent predictor of clinically relevant bile leakage after hepatic resection. Surgery 152:821–831

    Article  Google Scholar 

  24. Yokoo H, Miyata H, Konno H et al (2016) Models predicting the risks of six life-threatening morbidities and bile leakage in 14,970 liver resection patients registered in the national clinical database of Japan. Medicine (Baltimore) 95:e5466

    Article  Google Scholar 

  25. Martin AN, Narayanan S, Turrentine FE et al (2018) Clinical factors and postoperative impact of bile leak after liver resection. J Gastrointest Surg 22:661–667

    Article  Google Scholar 

  26. Kanazawa A, Tsukamoto T, Shimizu S et al (2013) Impact of laparoscopic liver resection for hepatocellular carcinoma with F4-liver cirrhosis. Surg Endosc 27:2592–2597

    Article  Google Scholar 

  27. Memeo R, de’Angelis N, Compagnon P, et al (2014) Laparoscopic versus open liver resection for hepatocellular carcinoma of cirrhotic liver: a case-control study. World J Surg 38:2919–2926

    Article  Google Scholar 

  28. Belli G, Fantini C, D’Agostino A et al (2007) Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results. Surg Endosc 21:2004–2011

    Article  CAS  Google Scholar 

  29. Nozawa H, Kitayama J, Sunami E et al (2012) Impact of chronic kidney disease on outcomes of surgical resection for primary colorectal cancer: a retrospective cohort review. Dis Colon Rectum 55:948–956

    Article  Google Scholar 

  30. Gansevoort RT, Correa-Rotter R, Hemmelgarn BR et al (2013) Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet 382:339–352

    Article  Google Scholar 

  31. Tonelli M, Wanner C (2014) Kidney disease: improving global outcomes lipid guideline development work group members. lipid management in chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2013 clinical practice guideline. Ann Intern Med 160:182–189

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8522, Japan

    Takahiro Yoshikawa, Takeo Nomi, Daisuke Hokuto, Naoki Kamitani, Yasuko Matsuo & Masayuki Sho

Authors
  1. Takahiro Yoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takeo Nomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daisuke Hokuto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naoki Kamitani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasuko Matsuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masayuki Sho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takeo Nomi.

Ethics declarations

Ethical approval

This study was approved by the institutional ethics review board of the Nara Medical University (No. 2312).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoshikawa, T., Nomi, T., Hokuto, D. et al. Outcomes in Patients with Chronic Kidney Disease After Liver Resection for Hepatocellular Carcinoma. World J Surg 45, 598–606 (2021). https://doi.org/10.1007/s00268-020-05829-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-020-05829-z

Search

Navigation