Morbidity and prognosis after hepatic resection for hepatocellular carcinoma in portal hypertensive cirrhotic patients

Abstract

Objective To evaluate the morbidity and prognosis after curative hepatectomy for hepatocellular carcinoma (HCC) in portal hypertensive (PH) cirrhotics.Method Clinical data of 523 patients with cirrhosis-related HCC from January 2001 to December 2010 undergoing hepatectomy at the Dept.of Hepatobiliary Surgery,the Affilated Hospital of Medical College,Qingdao University were studied retrospectively.Results There were 146 (27.9％) patients with PH (PH group) and 377 (72.1％)patients without PH (non-PH group).Patients with TACE before hepatectomy,Child-Pugh class B,serum albumin ＜35 g/L,blood transfusion and tumor size ≤5 cm in PH group were more than that in non-PH group.The mortality within 30 day after resection was 3.4％ in PH group and 0.5％ in non-group (P ＜0.05),the cause of death in PH group was related with liver disease.The postoperative morbidity was 28.1％ and 14.3％ in PH group and non-PH group (P ＜0.001).The overall survival (OS) rate after R0 resection was 46.8％ and 54.6％ in patients with PH and without PH (P =0.047),the disease-free survival was 37.0％ and 38.0％ (P =0.725).By Kaplan-Meier analysis:alcoholism,with PH,AFP≥20 ng/ml,tumor size ＞5 cm and non-solitary type HCC was important factors for OS; tumor size ＞5 cm and non-solitary type HCC was independent predictors for survival.Conclusions The mortality and morbidity in cirrhosis-related HCC patients with PH after R0 resection was higher than that in patients without PH,with most being related to liver disease.PH was not an independent predictor for cirrhosisrelated HCC patients' survival after R0 resection,although the OS time in these patients was significantly shorter than the patients without PH. Key words: Carcinoma, hepatocellular;  Hypertension, portal ;  Hepatectomy ;  Postoperative complications ;  Prognosis