title: Short- and long-term impact of reoperation for complications after major hepatectomy for hepatocellular carcinoma.
abstract: The impact of reoperation for complications after major liver resection for hepatocellular carcinoma was evaluated.
  
  
  
  In this retrospective study covering 25 years, patients with reoperation for complications after major liver resection for hepatocellular carcinoma were compared with patients without reoperation in terms of demographics, tumor characteristics, operative details, postoperative results, oncologic outcomes, and survival. Reasons for reoperation were also investigated.
  
  
  
  Forty-nine out of 1,092 patients underwent reoperation within a median of 0.2 days (range, 0-6.9 days) after hepatectomy. Patients with and without reoperation had similar baseline characteristics and liver function. Nonetheless, patients with reoperation had a higher indocyanine green retention rate at 15 minutes (12.55% vs 10.5%, P = .015), more operative blood loss (1.4 L vs 1 L, P = .012), a higher blood transfusion rate (44.9% vs 29.2%, P = .029), longer hospital stay (21 days vs 11 days, P < .001), a higher hospital mortality (38.8% vs 3.0%, P < .001), and a higher 90-day mortality (38.8% vs 4.7%, P < .001). Hemorrhage was the most common cause for reoperation (26/49, 53.1%), mainly resulting from coagulopathic bleeding from raw areas (12/26, 46.2%) and bleeding from diaphragmatic veins (6/26, 23.1%). However, reoperation did not affect 5-year overall survival (50.2% vs 48.3%, P = .468).
  
  
  
  Postoperative hemorrhage was associated with a high mortality, signifying the importance of meticulous hemostasis and careful perioperative management. Oncologic outcomes, however, were not affected by reoperation.
authors: Department of Surgery, The University of Hong Kong, Hong Kong, China.
authors: Wong Hoi
authors: WH
authors: She
authors: Department of Surgery, The University of Hong Kong, Hong Kong, China. Electronic address: acchan@hku.hk.
authors: Albert C Y
authors: AC
authors: Chan
authors: Department of Surgery, The University of Hong Kong, Hong Kong, China.
authors: Tan To
authors: TT
authors: Cheung
authors: Department of Surgery, The University of Hong Kong, Hong Kong, China.
authors: Kenneth S H
authors: KS
authors: Chok
authors: Department of Surgery, The University of Hong Kong, Hong Kong, China.
authors: Wing Chiu
authors: WC
authors: Dai
authors: Department of Surgery, The University of Hong Kong, Hong Kong, China.
authors: See Ching
authors: SC
authors: Chan
authors: Department of Surgery, The University of Hong Kong, Hong Kong, China.
authors: Chung Mau
authors: CM
authors: Lo
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012086:Reoperation / Q000379:methods / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome