title: [Risk factors of morbidity and mortality following surgical resection for hepatocellular carcinoma].
abstract: OBJECTIVE
  Recently, mortality following surgical resection for hepatocellular carcinoma has been reduced significantly. Morbidity, however, is still significant. This study evaluated the risk factors leading to morbidity and mortality.
  
  
  METHODS
  510 patients who had a hepatic resection form Nov. 1994 to Dec. 2001 were included. The patient demographics showed a mean age of 51.6 years with a male to female ratio of 4:1. The HBsAg was positive in 76.0% and the anti-HCV was positive in 8.2%. The mean tumor size was 5.2 cm, 26.2% of patients had preoperative transcatheter arterial embolization (TAE), and 8.7% had preoperative percutaneous transhepatic portal embolization (PTPE). Limited resection was performed in 259 cases (50.7%), and major resection was conducted in 251 cases (49.1%). Risk factors included age, sex, laboratory findings (liver function test, prothrombin time, albumin, glucose, alpha-fetoprotein, ICG test), preoperative TAE, PTPE, operation type, operation time, intraoperative transfusion, tumor size, and cirrhosis.
  
  
  RESULTS
  The morbidity was 10.5% (54 cases). Operative death occurred in 5 cases (1.0%). Hospital death, including operative death, occurred in 6 cases (1.2%). Five cases were associated with hepatic failure and 1 case was associated with aspiration pneumonia accompanying hepatic failure. Transfusion (P=0.002), glucose (P=0.002), and prothrombin time (P=0.038) were significantly related to morbidity. Age (P=0.028), glucose (P=0.011), and TAE (P=0.046) were significantly related to mortality.
  
  
  CONCLUSIONS
  Intraoperative transfusion, which is mainly related to intraoperative bleeding, should be reduced if possible to decrease morbidity. Diabetes mellitus patients and the elderly need careful perioperative management.
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea. jwjoh@smc.samsung.co.kr
authors.forename: Wan Wook
authors.initials: WW
authors.lastname: Kim
authors.forename: Kwang-Woong
authors.initials: KW
authors.lastname: Lee
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Heo
authors.forename: Yong Il
authors.initials: YI
authors.lastname: Kim
authors.forename: Sung Ju
authors.initials: SJ
authors.lastname: Kim
authors.forename: Dae Sung
authors.initials: DS
authors.lastname: Lee
authors.forename: Hwan Hyo
authors.initials: HH
authors.lastname: Lee
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Paik
authors.forename: Kwang Cheol
authors.initials: KC
authors.lastname: Koh
authors.forename: Joon Hyoek
authors.initials: JH
authors.lastname: Lee
authors.forename: Moon Seok
authors.initials: MS
authors.lastname: Choi
authors.forename: Byung Chul
authors.initials: BC
authors.lastname: Yoo
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Joh
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate