Abstract
BackgroundThe reduction of perioperative morbidity is a main surgical goal in patients undergoing partial hepatectomy for hepatocellular carcinoma (HCC). Here, we investigated clinical determinants of perioperative morbidity in a European cohort of patients undergoing surgical resection for HCC. MethodsA total 136 patients who underwent partial hepatectomy for HCC between 2011 and 2017 at our institution were included in this analysis. The associations between major surgical complications (Clavien-Dindo ≥ 3) and overall morbidity (Clavien-Dindo ≥ 1) with clinical variables were assessed using univariate and multivariable binary logistic regression analysis. ResultsMultivariable analysis identified the Child-Pugh-Score (CPS, HR = 3.23; p = 0.040), operative time (HR = 5.63; p = 0.003), and intraoperatively administered fresh frozen plasma (FFP, HR = 5.62; p = 0.001) as independent prognostic markers of major surgical complications, while only FFP (HR = 6.52; p = 0.001) was associated with morbidity in the multivariable analysis. The transfusion of FFP was not associated with perioperative liver functions tests. ConclusionsThe intraoperative administration of FFP is an important independent predictor of perioperative morbidity in patients undergoing partial hepatectomy for HCC.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide and its mortality ranks third among all solid tumors, behind only carcinomas of the lung and the colon.[1,2] Due to the underlying chronic liver disease in most patients with HCC, orthotopic liver transplantation (OLT) is considered the treatment of choice since it treats both underlying liver disease and the malignant tumor
A number of studies demonstrated that partial hepatectomy can be carried out safely even in patients with advanced liver disease.[6,7,8]
Recent advancements in the modern era of HCC-surgery include several strategies for the dynamic assessment of the liver function and the implementation of advanced laparoscopic liver surgery.[9,10]. While the latter resulted in comparable oncological results with reduced intraoperative blood loss and improved postoperative recovery, dynamic liver function tests such as the LiMAx, indocyanine green, and the hepatoimino diacetic acid (HIDA) test[9,11,12,13] provide a dynamic estimate of the functional liver reserve and improve the preoperative risk evaluation in these patients.[14,15]
Summary
Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide and its mortality ranks third among all solid tumors, behind only carcinomas of the lung and the colon.[1,2] Due to the underlying chronic liver disease in most patients with HCC, orthotopic liver transplantation (OLT) is considered the treatment of choice since it treats both underlying liver disease and the malignant tumor. Liver resections are increasingly utilized, since the availability of liver allografts remains low in many developed countries.[3,4,5] Correspondingly, a number of studies demonstrated that partial hepatectomy can be carried out safely even in patients with advanced liver disease.[6,7,8] This development is based on an improved preoperative assessment of patient-related risk factors for dismal operative outcome and the introduction of novel surgical techniques. The reduction of perioperative morbidity is a main surgical goal in patients undergoing partial hepatectomy for hepatocellular carcinoma (HCC). We investigated clinical determinants of perioperative morbidity in a European cohort of patients undergoing surgical resection for HCC. Methods A total 136 patients who underwent partial hepatectomy for HCC between 2011 and 2017 at our institution were included in this analysis. The associations between major surgical complications (Clavien-Dindo ≥ 3) and overall morbidity (Clavien-Dindo ≥ 1) with clinical variables were assessed using univariate and multivariable binary logistic regression analysis
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