Impact of Postoperative Complications on Long-Term Survival After Resection of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Kong, Junjie; Li, Guangbing; Chai, Jiawei; Guo, Yonglang; Liu, Yong; Li, Jun

doi:10.1245/s10434-021-10317-2

Cited by 23 publications

(15 citation statements)

References 60 publications

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“…Indeed, a meta-analysis of more than 4000 patients operated on in VL for hepatocarcinoma showed a reduction in 5-year all-cause mortality [ 20 ]. Another systematic review showed that a reduction in postoperative complications has a long-term effect on both OS and DFS [ 22 ]. These observations could mean that favorable postoperative outcome, which has been well studied in all fields of laparoscopy, has a positive and not fully explainable influence on long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Long-Term Outcomes of Video-Laparoscopic Versus Open Surgery in Obese Patients with Colorectal Cancer: A Propensity Score Matching Study

Bizzoca

Zupo

Castellana

et al. 2022

Cancers

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Background: Minimally invasive methods in colorectal surgery offer unquestionable advantages, especially in the context of obesity. The current study addresses the lack of scientific evidence on the long-term oncologic safety of video-laparoscopic (VL) approaches in excess-weight CRC patients undergoing surgery. Methods: We retrospectively analyzed a surgical database consisting of 138 CRC patients undergoing VL (n = 87, 63%) and open CRC surgery (n = 51, 37%). To reduce selection bias, a propensity score matching was applied as a preliminary step to balance the comparison between the two surgery groups, i.e., VL and open surgery. Data from patients treated by the same surgeon were used.to minimize bias. Additional Cox regression models were run on the matched sample (N = 98) to explore the observed benefits of VL surgery in terms of overall and cancer-free survival. The nonparametric Kaplan-Meier method was used to compare the two surgical approaches and assess the likelihood of survival and cancer relapse. Results: The study sample was mostly male (N = 86, 62.3%), and VL outnumbered open surgery (63% versus 37%). Both before and after the matching, the VL-allocated group showed better overall survival (p < 0.01) with comparable cancer-free survival over more than five years of median observation time (66 months). Kaplan Meier survival probability curves corroborated the VL significant protective effect on survival (HR of 0.32; 95% CI: 0.13 to 0.81) even after adjusting for major confounding factors (age, gender, comorbidity index, BMI, tumor localization, tumor staging, tumor grading, clearance, CRM). Findings on oncologic performance by tumor relapse were comparable but lacked significance due to the small number of events observed. Conclusions: Comparing CRC surgical approaches, VL allocation showed comparable cancer-free survival but also a better performance on overall mortality than open surgery over more than five years of median observation.

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Section: Discussionmentioning

confidence: 99%

Predictors of Long-Term Outcomes of Video-Laparoscopic Versus Open Surgery in Obese Patients with Colorectal Cancer: A Propensity Score Matching Study

Bizzoca

Zupo

Castellana

et al. 2022

Cancers

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“…A growing body of evidence indicates that postoperative complications, which in our series increased along with LLR difficulty, trigger the systemic proinflammatory cascade through the release of cytokines such as IL-1b, IL-6, TNF-a, oxidative stress, and immunosuppression and consequently promote tumorigenesis and metastatic spread ( 21 – 23 ). Postoperative complications have a negative impact on overall survival and disease-free survival in all types of malignancies ( 24 , 25 ). In addition, failure or delayed administration of adjuvant therapy due to postoperative complications may increase tumor recurrence and affect survival.…”

Section: Discussionmentioning

confidence: 99%

A novel difficulty scoring system of laparoscopic liver resection for liver tumor

Cheng

Zhu

et al. 2022

Front. Oncol.

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ObjectivesTo develop a novel difficulty scoring system (NDSS) to predict the surgical difficulty of laparoscopic hepatectomy.Patients and methodsA total of 138 patients with liver tumors performed liver resection (LLR) between March 2017 to June 2022 were selected from Affiliated Hospital of Jiangnan University and Wujin Hospital Affiliated with Jiangsu University.Patient demographics, laboratory tests, intraoperative variables, pathological characteristics were assessed. We also assessed the Child Pugh score and the DSS-B score.ResultsPatients were divided into training and testing cohort according to their hospital. Patients in training cohort were divided into high and low difficult groups based on operation time, blood loss and conversion. Higher percentage of patients with malignant liver tumor (87.0% vs. 58.1%; P = 0.003) or history of hepatobiliary surgery (24.1% vs. 7.0%; P = 0.043) in high difficult group than in low difficult group. To improve the difficulty scoring system, we incorporated the history of hepatobiliary surgery and nature of the tumor. A novel difficulty scoring system was established. The results showed that the operation time (P < 0.001), blood loss (P < 0.001), ALT (P < 0.001) and AST (P = 0.001) were associated with the novel difficulty score significantly. Compared with DSS-B, the NDSS has a higher area under the receiver operating characteristic (AUROC) (0.838 vs. 0.814). The nomogram was established according to the NDSS. The AUROCs of the nomogram in training and testing cohort were 0.833 and 0.767. The calibration curves for the probability of adverse event showed optimal agreement between the probability as predicted by the nomogram and the actual probability.ConclusionsWe developed a nomogram with the NDSS that can predict the difficulty of LLR. This system could more accurately reflect the difficulty of surgery and help liver surgeons to make the surgical plan and ensure the safety of the operation.

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Section: Introductionmentioning

confidence: 99%

“…[3,4] The safety of hepatectomy for HCC has improved gradually and the mortality rate has decreased significantly, but postoperative complications are still common, [5,6] which can seriously affect the prognosis of patients. [7][8][9] Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease closely related to insulin resistance and genetic susceptibility. The global prevalence of NAFLD is approximately 25%.…”

Section: Introductionmentioning

confidence: 99%

Impact of MAFLD on the complications after hepatectomy in patients with HBV-related hepatocellular carcinoma

et al. 2023

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Metabolic dysfunction-associated fatty liver disease (MAFLD) is a term that was proposed in 2020 by a group of international experts. However, the impact of MAFLD on complications after hepatectomy in patients with hepatocellular carcinoma is not clear. The aim of this study is to explore the influence of MAFLD on the complications after hepatectomy in patients with hepatitis B virus-related hepatocellular carcinoma (HBV-HCC). Patients with HBV-HCC who underwent hepatectomy between January 2019 and December 2021 were consecutively enrolled. The predictors of complications after hepatectomy in HBV-HCC patients were retrospectively analyzed. Among the 514 eligible HBV-HCC patients, 117 (22.8%) were diagnosed with concurrent MAFLD. Post hepatectomy complications occurred in 101 patients (19.6%), including 75 patients (14.6%) with infectious complications and 40 patients (7.8%) with major complications. Univariate analysis showed that MAFLD was not the risk factor for complications after hepatectomy in patients with HBV-HCC (P > .05). However, univariate and multivariate analysis revealed that lean-MAFLD was an independent risk factor for post hepatectomy complications in patients with HBV-HCC (odds ratio 2.245; 95% confidence interval 1.243-5.362, P = .028). Similar results were found in the analysis of predictors for infectious and major complications after hepatectomy in patients with HBV-HCC. MAFLD commonly coexists with HBV-HCC and is not directly associated with complications after hepatectomy, but lean-MAFLD is an independent risk factor for post hepatectomy complications in patients with HBV-HCC.Abbreviations: 95% CI = 95% confidence intervals, BMI = body mass index, HBV = hepatitis B virus, HBV-HCC = hepatitis B virus-related hepatocellular carcinoma, HCC = hepatocellular carcinoma, HCV = hepatitis C virus, MAFLD = metabolic dysfunctionassociated fatty liver disease, NAFLD = nonalcoholic fatty liver disease, OR = odds ratio, T2DM = type 2 diabetes mellitus.

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Impact of Postoperative Complications on Long-Term Survival After Resection of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Cited by 23 publications

References 60 publications

Predictors of Long-Term Outcomes of Video-Laparoscopic Versus Open Surgery in Obese Patients with Colorectal Cancer: A Propensity Score Matching Study

Predictors of Long-Term Outcomes of Video-Laparoscopic Versus Open Surgery in Obese Patients with Colorectal Cancer: A Propensity Score Matching Study

A novel difficulty scoring system of laparoscopic liver resection for liver tumor

Impact of MAFLD on the complications after hepatectomy in patients with HBV-related hepatocellular carcinoma

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