A Study Into the Risk of Exacerbation of Chronic Hepatitis B After Liver Resection for Hepatocellular Carcinoma

Abstract

Liver resection is commonly performed for solitary hepatocellular carcinoma (HCC) in well-compensated cirrhotic and noncirrhotic patients. Data concerning exacerbation of chronic hepatitis B (ECHB) post-liver resection are scant. To determine the incidence, risk factors, and clinical outcomes of ECHB in patients who underwent hepatic resection for HCC. The methods consisted of a retrospective review of consecutive patients with chronic hepatitis B virus (HBV) infection who had undergone liver resection for HCC from January 2002 to December 2004. Seventy-seven patients underwent 82 liver resections; the mean age was 58.0 +/- 12.1 years; 87% male; 20% hepatitis B e-antigen positive. Incidence of all causes of postoperative hepatitis was 25.6% (n = 21), and ECHB was 8.5% (n = 7). Both groups had their peak alanine aminotransferases, 231.0 IU/L (74-1,400) and 312 IU/L (147-1,400), respectively, observed at day 84 postresection. Three patients died as a result of ECHB within 4 months postsurgery. One- and 2-year survival rates were poorest for the ECHB group at 42.9 and 21.4%, compared with those with postoperative hepatitis due to other causes at 60.3 and 45.2% and those without postoperative hepatitis at 87.7 and 73.5% (p < 0.001). Liver resection for HCC in patients with chronic HBV infection carries a risk for ECHB, and affected patients have poorer clinical outcomes. There is a need for close monitoring of these patients preoperatively and in the early postoperative period.

Efficacy of antiviral therapy with nucleotide/nucleoside analogs after curative treatment for patients with hepatitis B virus-related hepatocellular carcinoma: A systematic review and meta-analysis

“…Several reasons could account for the decreased mortality. First, antiviral therapy could improve the liver function of HBV-related HCC patients, as confirmed by several studies [30,39]. Koda et al [28] reported that the cumulative survival rates of HBV-related HCC patients after NA was administered were significantly increased, following serum albumin, AST, and ALT levels were improved, and ChildPugh scores were reduced compared with the baseline.…”

Antiviral therapy improves post‐hepatectomy survival in patients with hepatitis B virus‐related hepatocellular carcinoma: a prospective‐retrospective study

“…The postulated benefit of prophylactic antiviral therapy before liver resection based on the use of nucleos(t)ide analogues to reduce the risk of HBV reactivation related to TACE . Recent studies showed that liver resection for HCC in patients with chronic HBV infection carries a risk for exacerbation of chronic hepatitis B, and affected patients have worst clinical outcomes . An effective pre‐operative anti‐HBV therapy could therefore contribute to an improvement in liver function, by means of reducing perioperative HBV reactivation .…”

“…Remnant liver function is a major determining factor in selecting subsequent treatment for HCC recurrence and is a key prognostic factor for the overall survival. Antiviral therapy enhances the post‐operative viral clearance, improve residual liver volume, and promote hepatocyte regeneration in HCC patients with active hepatitis B . These effects may significantly improve the tolerance to subsequent therapy and possibly lower rate of recurrence and deaths.…”

Letter: pre‐ and post‐operative anti‐viral therapy is important for patients with hepatitis B virus‐related hepatocellular carcinoma – authors’ reply

“…Hepatic resection may cause hepatitis B virus (HBV) reactivation and subsequent fulminant hepatitis, liver failure or death. 3 We agree that it is more appropriate to initiate anti-viral therapy before liver resection, as anti-viral therapy has been shown to significantly reduce the rate of HBV reactivation. 4 However, due to logistic reasons, not every patient is able to receive anti-viral therapy before resection.…”