[Risk factors of morbidity and mortality following surgical resection for hepatocellular carcinoma].
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.
Kim
Wan Wook
WW
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea. jwjoh@smc.samsung.co.kr
Lee
Kwang-Woong
KW
Choi
Sung Ho
SH
Heo
Jin Seok
JS
Kim
Yong Il
YI
Kim
Sung Ju
SJ
Lee
Dae Sung
DS
Lee
Hwan Hyo
HH
Paik
Seung Woon
SW
Koh
Kwang Cheol
KC
Lee
Joon Hyoek
JH
Choi
Moon Seok
MS
Yoo
Byung Chul
BC
Joh
Jae Won
JW
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