title: Upper abdominal shape as a risk factor of extended operation time and severe postoperative complications in HCC hepatectomy through subcostal incision.
abstract: BACKGROUND
  Subcostal incision is the most widely used approach in open surgery for patients with hepatocellular carcinoma (HCC). Body shape is recognised to be a factor influencing the difficulty of surgery; however, the exact impact of the increased difficulty on the patients' operation as well as the outcome has not been analysed. In this study, we retrospectively studied the possible influence of patients' body shape, tumour burden and varied surgical methods on the operation procedure and postoperative complications.
  
  
  METHODS
  From January 2009 to December 2013, 651 patients with HCC were included in the study. We studied the patients' sex, age, body mass index, upper abdominal body shape described by the depth-to-width ratio for the trunk at the celiac axis on CT/MRI, Child-Pugh classification, tumour burden and a different liver dissection method before the surgery and used a regression model for analysis.
  
  
  RESULTS
  Prolonged operation time is associated with advanced tumour stage, large CA ratio, previous abdominal surgery, selective hepatic vascular occlusion and dissecting with Cavitron ultrasonic surgical aspirator rather than clamp crushing. Surgical blood loss is associated with operation time, liver function and a different liver dissection method. The incidence of severe postoperative complication was 17.5% (114/651) and was associated with larger CA ratio, Child-Pugh stage B liver function and greater blood loss.
  
  
  CONCLUSIONS
  Large upper abdominal shape is a risk factor of both prolonged operation time and severe postoperative complication. CA ratio combined with liver function and surgical blood loss has an acceptable power to predict severe postoperative complications.
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China. houyifu0726@foxmail.com.
authors.forename: Yi-fu
authors.initials: YF
authors.lastname: Hou
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China. yourwyg@163.com.
authors.forename: Yong-gang
authors.initials: YG
authors.lastname: Wei
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China. cdlibo@medmail.com.cn.
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China. docjackyang@163.com.
authors.forename: Jia-yin
authors.initials: JY
authors.lastname: Yang
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China. ccwentianfu@sohu.com.
authors.forename: Tian-fu
authors.initials: TF
authors.lastname: Wen
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China. xumingqing0018@163.com.
authors.forename: Ming-qing
authors.initials: MQ
authors.lastname: Xu
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China. yanlunan688@163.com.
authors.forename: Lv-nan
authors.initials: LN
authors.lastname: Yan
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China. wwt02@163.com.
authors.forename: Wen-tao
authors.initials: WT
authors.lastname: Wang
mesh_terms: D000005:Abdomen / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D047368:Tumor Burden; D055815:Young Adult