Liver resection for HCC: analysis of causes and risk factors linked to postoperative complications.
OBJECTIVE
Hepatic resection is widely accepted as the best treatment for localized hepatocellular carcinoma (HCC), even in those patients affected by cirrhosis after a sharp selection. Notwithstanding technical advances and high experience of liver resection of specialized centers, the rate of complication after surgical resection could be high. Herein we analyzed causes and foreseeable risk factors on the grounds of data derived from a single center surgical population.


METHODS
From September 1989 to March 2005, 134 consecutive patients had liver resection for HCC on cirrhosis at our department. We performed 54 major liver resections and 80 limited resections.


RESULTS
In-hospital mortality rate was 7.4%, about 50% of these cases were Child-Pugh B patients. Morbidity rate was 47.7%, caused by the rising of ascites, hepatic insufficiency, biliary fistula, hepatic abscess, hemoperitoneum and pleural effusion. Intraoperative mortality resulted to be influenced by the amount of resected liver volume (p < 0.05), and the rising of complication (p = 0.006). Some technical aspects of surgical procedure are responsible of the rising of complication as: Pringle maneuver length (p = 0.02), the amount of resected liver volume (p = 0.03) and the request of blood transfusion (p = 0.03).


CONCLUSIONS
Complications that arise during the postoperative period, although treatable, delay patient's recovery and resumption of liver function; the evaluation of causes and foreseeable risk factors linked to postoperative morbidity during the planning of surgical treatment should play the same role as other factors weighted in the selection of patients eligible for liver resection.
Benzoni
Enrico
E
Department of Surgery, University of Udine, School of Medicine, Italy. enricobenzoni@yahoo.it
Molaro
Roberta
R
Cedolini
Carla
C
Favero
Alessandro
A
Cojutti
Alessandro
A
Lorenzin
Dario
D
Intini
Sergio
S
Adani
Gian Luigi
GL
Baccarani
Umberto
U
Bresadola
Fabrizio
F
Uzzacu
Alessandro
A
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis