title: [Impact of surgical operation-related factors on long-term survival of patients with hepatocellular carcinoma after hepatectomy].
abstract: OBJECTIVE
  To evaluate the prognostic value of surgical operation-related factors in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  The clinical data of 234 patients after hepatic resection (214 men and 20 women) were retrospectively studied. Univariate and multivariate COX regression analyses were performed for surgical operation-related prognostic factors including age, gender, intraoperative blood loss, iatrogenic tumour rupture, transfusion, operation duration, hepatectomy extent, Pringle manoeuvre, with or without devarscularization, and complications (e.g. postoperative ascites, biliary leakage, incision infection, and pleural effusion). Kaplan-Meier and log-rank tests were used to compare survival rates. Kendall's tau bivariate analyses were used to examine the correlations of these surgical operation-related factors.
  
  
  RESULTS
  Univariate COX regression analysis revealed that iatrogenic blood loss (chi2 = 19.721, P < 0.001), transfusion (chi2 = 7.769, P = 0.005), tumour rupture (chi2 = 6.401, P = 0.011), operation duration (chi2 = 4.793, P = 0.029), and postoperative ascites (chi2 = 4.452, P = 0.035) were statistically significant predictors in patients with HCC after hepatic resection. Multivariate COX regression analysis revealed that pathological factors, such as blood loss (RR: 2.138, 95% CI: 1.556-2.939), tumour rupture (RR: 2.260, 95% CI: 1.182-4.321), and postoperative ascites (RR: 1.648, 95% CI: 1.088-2.469), independently influenced the HCC prognosis. Blood loss correlated with transfusion (Kendall's tau = 0.416, P < 0.001). There was no correlation between hepatectomy extent and blood loss (Kendall's tau = 0.057, P = 0.383), while transfusion closely correlated with the hepatectomy extent (Kendall's tau = 0.185, P = 0.004). The postoperative ascites closely correlated with Child classification (Kendall's tau = 0.151, P = 0.024).
  
  
  CONCLUSIONS
  The long-term survival of patients with HCC after hepatectomy may be improved by avoiding blood loss and iatrogenic tumour rupture. The indications of blood transfusion may not be strictly obeyed in some severe cases. Child class B and C cirrhotic patients may experience postoperative ascites and a worse prognosis, and therefore may be candidates for liver transplantation.
authors.affiliation: Department of Hepatobiliary Surgery, PLA General Hospital, Beijing 100853, China.
authors.forename: Wen-ping
authors.initials: WP
authors.lastname: Lü
authors.forename: Jia-hong
authors.initials: JH
authors.lastname: Dong
authors.forename: Wen-zhi
authors.initials: WZ
authors.lastname: Zhang
authors.forename: Xiao-qiang
authors.initials: XQ
authors.lastname: Huang
authors.forename: Shu-guang
authors.initials: SG
authors.lastname: Wang
authors.forename: Ping
authors.initials: P
authors.lastname: Bie
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007431:Intraoperative Complications; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult