Postoperative morbidity adversely impacts long-term oncologic prognosis following hepatectomy for hepatocellular carcinoma: A multicenter observational study

Eur J Surg Oncol. 2021 Oct;47(10):2551-2560. doi: 10.1016/j.ejso.2021.04.027. Epub 2021 Apr 26.

Abstract

Background & aims: Postoperative morbidity following hepatectomy for hepatocellular carcinoma (HCC) is common and its impact on long-term oncological outcome remains unclear. This study aimed to investigate if postoperative morbidity impacts long-term survival and recurrence following hepatectomy for HCC.

Methods: The data from a multicenter Chinese database of curative-intent hepatectomy for HCC were analyzed, and independent risks of postoperative 30-day morbidity were identified. After excluding patients with postoperative early deaths (≤90 days), early (≤2 years) and late (>2 years) recurrence rates, overall survival (OS), and time-to-recurrence (TTR) were compared between patients with and without postoperative morbidity.

Results: Among 2,161 patients eligible for the study, 758 (35.1%) had postoperative 30-day morbidity. Multivariable logistic regression analysis showed that diabetes mellitus, obesity, Child-Pugh grade B, cirrhosis, and intraoperative blood transfusion were independent risks of postoperative morbidity. The rates of early and late recurrence among patients with postoperative morbidity were higher than those without (50.7% vs. 38.8%, P < 0.001; and 41.7% vs. 34.1%, P = 0.017). Postoperative morbidity was associated with decreased OS (median: 48.1 vs. 91.6 months, P < 0.001) and TTR (median: 19.8 vs. 46.1 months; P < 0.001). After adjustment of confounding factors, multivariable Cox-regression analyses revealed that postoperative morbidity was associated with a 27.8% and 18.7% greater likelihood of mortality (hazard ratio 1.278; 95% confidence interval: 1.126-1.451; P < 0.001) and recurrence (1.187; 1.058-1.331; P = 0.004).

Conclusion: This large multicenter study provides strong evidence that postoperative morbidity adversely impacts long-term oncologic prognosis after hepatectomy for HCC. The prevention and management of postoperative morbidity may be oncologically important.

Keywords: Hepatectomy; Hepatocellular carcinoma; Morbidity; Recurrence; Survival.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Blood Transfusion
  • Carcinoma, Hepatocellular / complications
  • Carcinoma, Hepatocellular / surgery*
  • Diabetes Complications / complications
  • Female
  • Hepatectomy / adverse effects*
  • Humans
  • Liver Cirrhosis / complications
  • Liver Neoplasms / complications
  • Liver Neoplasms / surgery*
  • Male
  • Middle Aged
  • Obesity / complications
  • Postoperative Complications / etiology*
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Time Factors