Is HCC associated with worse surgical outcomes compared to CRLM?

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Purpose: The purpose of this study is to understand the incidence of complications associated with open liver resections for liver tumors with respect to regional variation and disease specific incidence. Methods: A systematic literature review of the incidence (weighted average) of complications and correlating factors during open liver resection published during the past five years were analyzed. Results: In total, 139 manuscripts and 29 abstracts met the study criteria providing data on 540,397 [MG1] liver resections. 46% of studies were conducted in Asia Pac, 27%-Europe, and 23%-North America. 78% of studies focusing on HCC were from Asia Pacific whereas 77% of focusing on CRLM were from Europe/North America. The average mortality was 3.8% and morbidity 36.4%. Ascites (25.6%), post hepatectomy liver failure (11.9%), bile leak (7.7%) and SSI (7.1%) were the most common non-hemorrhagic complications. Disease specific surgical mortality was 3.6 % for CRLM and 1.7% for HCC. Morbidity was also slightly higher in CRLM (38.1%) versus studies of HCC alone (30.9%). The specific transfusion rate for CRLM was 29.4% and for HCC 19.7%. Conclusions: Bleeding, bile leak, ascites, and PHLF remain prominent complications in liver resection procedures and contribute to a mortality rate of approximately 4%. Findings from this study may challenge traditional beliefs that cirrhosis is the most important contributor to mortality and transfusion after liver surgery; that rates of transfusion are greater in the Asia Pacific region; and that cirrhosis (HCC) is associated with worse surgical outcomes than CRLM.