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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2017

01-06-2017 | Hepatobiliary Tumors

Complications after Hepatectomy for Hepatocellular Carcinoma Independently Shorten Survival: A Western, Single-Center Audit

Authors: Alexandre Doussot, MD, Chetana Lim, MD, Eylon Lahat, MD, Chady Salloum, MD, Michael Osseis, MD, Concepción Gómez Gavara, MD, Eric Levesque, MD, Cyrille Feray, MD, PhD, Philippe Compagnon, MD, PhD, Daniel Azoulay, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2017

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Abstract

Background

The impact of postoperative complications (POCs) on long-term outcomes following hepatocellular carcinoma (HCC) resection remains to be ascertained.

Methods

All consecutive HCC resected at a single center were analyzed. Patients with POCs, classified according to Clavien classification, were compared to those without in terms of demographics, pathology, management, overall survival (OS), and disease-free survival (DFS). Independent prognostic factors of POCs were identified using multivariable regression models.

Results

Among 341 patients, overall POCs rate was 34% (n = 116) and grade III–IV POCs rate was 14.4% (n = 49). POCs were an independent negative factor for OS [hazard ratio (HR) 1.40, 95% confidence interval (CI) 1.12–2.26, p = 0.009] with BCLC stage, the need for combined procedure, intraoperative transfusion, and the METAVIR score of the underlying parenchyma. Similarly, occurrence of POCs was associated independently with DFS (HR 1.59, 95% CI 1.18–2.15, p = 0.002), together with the presence of portal hypertension, BCLC stage, the need for combined procedure, intraoperative transfusion, and the presence of satellite nodules. After stratification, the negative impact of morbidity on OS and DFS reached statistical significance in the BCLC stage A subset only (p = 0.026, and p < 0.001, respectively). Open resection, intraoperative transfusion, and the existence of underlying liver injury were independent predictors of POCs.

Conclusions

POCs should be considered as a long-term prognostic factor. Careful patient selection requiring underlying liver assessment and appropriate strategy, such as mini-invasive surgery and restricted transfusion policy, might be promoted to prevent POCs.
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Metadata
Title
Complications after Hepatectomy for Hepatocellular Carcinoma Independently Shorten Survival: A Western, Single-Center Audit
Authors
Alexandre Doussot, MD
Chetana Lim, MD
Eylon Lahat, MD
Chady Salloum, MD
Michael Osseis, MD
Concepción Gómez Gavara, MD
Eric Levesque, MD
Cyrille Feray, MD, PhD
Philippe Compagnon, MD, PhD
Daniel Azoulay, MD, PhD
Publication date
01-06-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5746-6

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