Postoperative morbidity adversely impacts long-term oncologic prognosis following hepatectomy for hepatocellular carcinoma: A multicenter observational study

Li, Lin-Qiang; Liang, Lei; Yang, Tian; Li, Chao; Wu, Han; Zhang, Yaoming; Zhang, Wanguang; Wang, Hong; Zhou, Ya-Hao; Gu, Wei‐Min; Chen, Ting‐Hao; Li, Jie; Liang, Yingjian; Xu, Qiuran; Diao, Yong-Kang; Jia, Hang‐Dong; Wang, Mingda; Zhang, Chengwu; Shen, Feng; Huang, Dongsheng; Yang, Tian

doi:10.1016/j.ejso.2021.04.027

Cited by 12 publications

(14 citation statements)

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“…In addition, a study from Japan observed that 21 patients (35.0%) had remarkable postoperative complications, while the presence of complications predicted worse outcomes in intrahepatic cholangiocarcinoma patients[ 14 ]. A large-sample multicenter study from China indicated that 758 (35.1%) out of 2161 HCC patients experienced morbidity within 30 d, and the median OS and time-to-recurrence in these patients were poorer (48.1 mo vs 91.6 mo and 19.8 mo vs 46.1 mo, respectively)[ 8 ]. However, no studies have investigated the link between postoperative morbidity and prognosis in HCCA patients.…”

Section: Discussionmentioning

confidence: 99%

“…In other cancers, postoperative morbidity may be an independent predictor of poor prognostic outcome, including colorectal liver metastasis[ 37 ], HCC[ 8 , 38 , 39 ], pancreatic cancer[ 40 ], and esophageal cancer[ 41 ]. Although the precise association between postoperative morbidity and unfavorable prognostic outcomes remains to be elucidated, there are several possible explanations.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have demonstrated that postoperative morbidity is linked to greater recurrence and lower survival rates than many other gastrointestinal tumors, such as HCC[ 8 ], pancreatic[ 9 ], gastric[ 10 , 11 ], and colorectal carcinomas[ 12 , 13 ], as well as intrahepatic cholangiocarcinoma[ 14 ]. Systemic inflammation may result from postoperative morbidity, which could, in turn, reduce the effectiveness of the immune response against the tumor[ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Postoperative morbidity adversely impacts oncological prognosis after curative resection for hilar cholangiocarcinoma

Liu¹,

Chen²,

Zhang³

et al. 2022

WJG

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BACKGROUND Postoperative morbidity after curative resection for hilar cholangiocarcinoma (HCCA) is common; however, whether it has an impact on oncological prognosis is unknown. AIM To evaluate the influence of postoperative morbidity on tumor recurrence and mortality after curative resection for HCCA. METHODS Patients with recently diagnosed HCCA who had undergone curative resection between January 2010 and December 2017 at The First Affiliated Hospital of Army Medical University in China were enrolled. The independent risk factors for morbidity in the 30 d after surgery were investigated, and links between postoperative morbidity and patient characteristics and outcomes were assessed. Postoperative morbidities were divided into five grades based on the Clavien-Dindo classification, and major morbidities were defined as Clavien-Dindo ≥ 3. Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for recurrence-free survival (RFS) and overall survival (OS). RESULTS Postoperative morbidity occurred in 146 out of 239 patients (61.1%). Multivariate logistic regression revealed that cirrhosis, intraoperative blood loss > 500 mL, diabetes mellitus, and obesity were independent risk factors. Postoperative morbidity was associated with decreased OS and RFS (OS: 18.0 mo vs 31.0 mo, respectively, P = 0.003; RFS: 16.0 mo vs 26.0 mo, respectively, P = 0.002). Multivariate Cox regression analysis indicated that postoperative morbidity was independently associated with decreased OS [hazard ratios (HR): 1.557, 95% confidence interval (CI): 1.119-2.167, P = 0.009] and RFS (HR: 1.535, 95%CI: 1.117-2.108, P = 0.008). Moreover, major morbidity was independently associated with decreased OS (HR: 2.175; 95%CI: 1.470-3.216, P < 0.001) and RFS (HR: 2.054; 95%CI: 1.400-3.014, P < 0.001) after curative resection for HCCA. CONCLUSION Postoperative morbidity (especially major morbidity) may be an independent risk factor for unfavorable prognosis in HCCA patients following curative resection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postoperative morbidity adversely impacts oncological prognosis after curative resection for hilar cholangiocarcinoma

Liu¹,

Chen²,

Zhang³

et al. 2022

WJG

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“…[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%

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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Anatomic versus non‐anatomic liver resection for hepatocellular carcinoma—A European multicentre cohort study in cirrhotic and non‐cirrhotic patients

Zeindler,

Hess,

von Heesen

et al. 2024

Cancer Medicine

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BackgroundThe incidence of hepatocellular carcinoma (HCC) is increasing in the western world over the past decades. As liver resection (LR) represents one of the most efficient treatment options, advantages of anatomic (ALR) versus non‐anatomic liver resection (NALR) show a lack of consistent evidence. Therefore, the aim of this study was to investigate complications and survival rates after both resection types.MethodsThis is a multicentre cohort study using retrospectively and prospectively collected data. We included all patients undergoing LR for HCC between 2009 and 2020 from three specialised centres in Switzerland and Germany. Complication and survival rates after ALR versus NALR were analysed using uni‐ and multivariate Cox regression models.ResultsTwo hundred and ninety‐eight patients were included. Median follow‐up time was 52.76 months. 164/298 patients (55%) underwent ALR. Significantly more patients with cirrhosis received NALR (n = 94/134; p < 0.001). Complications according to the Clavien Dindo classification were significantly more frequent in the NALR group (p < 0.001). Liver failure occurred in 13% after ALR versus 8% after NALR (p < 0.215). Uni‐ and multivariate cox regression models showed no significant differences between the groups for recurrence free survival (RFS) and overall survival (OS). Furthermore, cirrhosis had no significant impact on OS and RFS.ConclusionNo significant differences on RFS and OS rates could be observed. Post‐operative complications were significantly less frequent in the ALR group while liver specific complications were comparable between both groups. Subgroup analysis showed no significant influence of cirrhosis on the post‐operative outcome of these patients.

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Postoperative morbidity adversely impacts long-term oncologic prognosis following hepatectomy for hepatocellular carcinoma: A multicenter observational study

Cited by 12 publications

References 49 publications

Postoperative morbidity adversely impacts oncological prognosis after curative resection for hilar cholangiocarcinoma

Postoperative morbidity adversely impacts oncological prognosis after curative resection for hilar cholangiocarcinoma

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

Anatomic versus non‐anatomic liver resection for hepatocellular carcinoma—A European multicentre cohort study in cirrhotic and non‐cirrhotic patients

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