title: A study into the risk of exacerbation of chronic hepatitis B after liver resection for hepatocellular carcinoma.
abstract: Liver resection is commonly performed for solitary hepatocellular carcinoma (HCC) in well-compensated cirrhotic and noncirrhotic patients. Data concerning exacerbation of chronic hepatitis B (ECHB) post-liver resection are scant. To determine the incidence, risk factors, and clinical outcomes of ECHB in patients who underwent hepatic resection for HCC. The methods consisted of a retrospective review of consecutive patients with chronic hepatitis B virus (HBV) infection who had undergone liver resection for HCC from January 2002 to December 2004. Seventy-seven patients underwent 82 liver resections; the mean age was 58.0 +/- 12.1 years; 87% male; 20% hepatitis B e-antigen positive. Incidence of all causes of postoperative hepatitis was 25.6% (n = 21), and ECHB was 8.5% (n = 7). Both groups had their peak alanine aminotransferases, 231.0 IU/L (74-1,400) and 312 IU/L (147-1,400), respectively, observed at day 84 postresection. Three patients died as a result of ECHB within 4 months postsurgery. One- and 2-year survival rates were poorest for the ECHB group at 42.9 and 21.4%, compared with those with postoperative hepatitis due to other causes at 60.3 and 45.2% and those without postoperative hepatitis at 87.7 and 73.5% (p < 0.001). Liver resection for HCC in patients with chronic HBV infection carries a risk for ECHB, and affected patients have poorer clinical outcomes. There is a need for close monitoring of these patients preoperatively and in the early postoperative period.
authors.affiliation: Department of Gastroenterology and Hepatology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. kelvin.thia.t.j@singhealth.com.sg
authors.forename: Teck Joo Kelvin
authors.initials: TJ
authors.lastname: Thia
authors.forename: Hock Foong
authors.initials: HF
authors.lastname: Lui
authors.forename: Lucien London
authors.initials: LL
authors.lastname: Ooi
authors.forename: Yaw Fui
authors.initials: YF
authors.lastname: Chung
authors.forename: Pierce Kah-Hoe
authors.initials: PK
authors.lastname: Chow
authors.forename: Peng Chung
authors.initials: PC
authors.lastname: Cheow
authors.forename: Yu Meng
authors.initials: YM
authors.lastname: Tan
authors.forename: Wan Cheng
authors.initials: WC
authors.lastname: Chow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006505:Hepatitis / Q000209:etiology; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000503:physiopathology*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase