Impairment of perioperative activities of daily living is associated with poor prognosis following hepatectomy for hepatocellular carcinoma

Abstract

Background The number of cancer patients with impairment of activities of daily living (ADLs) has increased. This study aimed to examine associations of perioperative Barthel index score, a validated measure of ADLs, with survival outcomes following hepatectomy for hepatocellular carcinoma (HCC). Methods We analyzed data of 492 consecutive patients who underwent hepatectomy for HCC between 2010 and 2018. Pre‐ and postoperative ADLs were assessed using the Barthel index (range, 0–100; higher scores indicate greater independence). Preoperative Barthel index score ≤85 or postoperative Barthel index score ≤85 was defined as impairment of perioperative ADLs. Cox proportional hazards regression was used to calculate hazard ratios (HRs) after adjusting for potential confounders. Results Among the 492 patients, 26 (5.2%) had a preoperative Barthel index score ≤85 and 95 (19%) had a postoperative Barthel index score ≤85. Impairment of perioperative ADLs was independently associated with shorter overall survival (multivariable HR: 1.75, 95% confidence interval [CI]: 1.06–2.81, p = 0.028). The association of impairment of perioperative ADLs with recurrence‐free survival was not statistically significant. Conclusion Impairment of perioperative ADLs is associated with poor prognosis following hepatectomy for HCC. Maintenance and improvement of perioperative ADLs would be important to provide favorable long‐term outcomes in patients with HCC.

Disability in perioperative activities of daily living is associated with worse survival outcomes following hepatic resection in patients with intrahepatic cholangiocarcinoma

“…We found the associations of disability in perioperative ADL with worse surgical outcomes and poor prognosis after hepatic resection for ICC. No significant associations of perioperative ADL with surgical outcomes and recurrence after hepatectomy were observed in our previous study of HCC 13 . Although the mechanisms by which disability in perioperative ADL correlates with worse surgical outcomes and shorter RFS in ICC, but not HCC, are largely unknown, this discrepancy might be due to differences in the pathophysiology or tumor aggressiveness between ICC and HCC.…”

“…No significant associations of perioperative ADL with surgical outcomes and recurrence after hepatectomy were observed in our previous study of HCC. 13 Although the mechanisms by which disability in perioperative ADL correlates with worse surgical outcomes and shorter RFS in ICC, but not HCC, are largely unknown, this discrepancy might be due to differences in the pathophysiology or tumor aggressiveness between ICC and HCC. Nevertheless, further studies are required to validate the findings from the current study, and to elucidate the associations of perioperative ADL with surgical We acknowledge two main limitations of the present study.…”

“…[7][8][9] Vulnerable or frail patients with gastrointestinal cancers are more likely to have poor tolerance of treatment, worse surgical outcomes, and a poor prognosis. [10][11][12][13] Hence, the identification and improvement of disability in ADL may improve these patients' outcomes. The Barthel index is widely used as an assessment tool for evaluating ADL and yields a score of 0-100 points, with higher scores indicating greater independence.…”

“…With the rapidly aging global population, the number of patients with cancer who develop disability in activities of daily living (ADL) has increased 7–9 . Vulnerable or frail patients with gastrointestinal cancers are more likely to have poor tolerance of treatment, worse surgical outcomes, and a poor prognosis 10–13 . Hence, the identification and improvement of disability in ADL may improve these patients' outcomes.…”

Impact of functional impairment and cognitive status on perioperative outcomes and costs after radical cystectomy: The role of Barthel Index

“…For example, Mima et al. showed that BI ≤85 was associated with poor prognosis in 492 patients with hepatocellular carcinoma following surgical treatment 27 . The same investigators found that lower BI scores were associated with shorter recurrence free‐survival and overall survival in 815 nonmetastatic surgically treated colorectal cancer patients 28 .…”