Abstract
BackgroundPoor preoperative nutritional and immunological status are major risk factors for postoperative complications in patients with various malignancies. Lower preoperative prognostic nutrition index (PNI) is associated with higher rates of postoperative complications and poorer prognosis in those patients. The aim of this study was to analyze the predictive value of the PNI for post-hepatectomy complications in patients with hepatocellular carcinoma (HCC), and evaluate its utility in the surgical procedure. MethodsThis retrospective study included 510 patients who underwent open hepatectomies for HCC. The predictive value of the preoperative nutritional and immunological status for postoperative complications was assessed using the PNI. Postoperative complications were defined as grade II or higher per the Clavien-Dindo classification. Postoperative complication rates were compared according to surgical procedure (major hepatectomy vs minor hepatectomy). ResultsPatients with postoperative complications had significantly lower PNIs than those without (43.1±5.5 vs 47.0 ± 5.7, P < 0.001). In the multivariate analysis, low preoperative PNI (< 45) was an independent risk factor for postoperative complications after hepatectomy (hazard ratio, 3.85). When patients were classified per their PNI (high vs low) and extent of surgical procedures (major vs minor), there were more complications among patients with low PNI than those with high PNI, regardless of the extent of surgical procedures. Specifically, the group of patients with low PNI who underwent major hepatectomy had significantly higher rates of postoperative complications than the other groups. ConclusionsAdding the resection range to the PNI is useful for predicting the postoperative morbidities of hepatectomy patients.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide.[1]
The preoperative factors evaluated as potential predictors of postoperative morbidity in patients included patient age, sex, and body mass index; presence of the surface antigen of hepatitis B virus (HBV) or antibody to hepatitis C virus (HCV); diabetes mellitus; the American Society of Anesthesiologists (ASA) physical status class; primary or recurrent hepatocellular carcinoma (HCC); serum concentration of albumin, total bilirubin, total lymphocyte count of the peripheral blood, and prothrombin time; indocyanine green retention rate at 15 min (ICGR15); the Child-Pugh classification; and serum concentrations of alpha-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP)
Compared with the no complication group, the complication group had a higher rate of HCV positivity (54.2% vs 66.7%, P = 0.013), an ASA class III (16% vs 37%, P < 0.001), and a Child-Pugh class B (5.8% vs 12.1%, P = 0.021)
Summary
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide.[1]. The main curative treatment for HCC is hepatic resection. Previous studies have identified several risk factors for postoperative morbidity after hepatectomy for patients with HCC.[10,11,12,13,14,15] Preoperative poor nutritional and immunological status have been associated with postoperative morbidity and poor long-term outcomes of patients with malignant tumors.[16,17,18,19,20,21] The prognostic nutritional index (PNI) is a widely used combined measure of the nutritional and immunological status, and is calculated using serum albumin concentrations and total lymphocyte counts in the peripheral blood. The aim of this study was to analyze the predictive value of the PNI for post-hepatectomy complications in patients with hepatocellular carcinoma (HCC), and evaluate its utility in the surgical procedure
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