Risk factors for early mortality after hepatectomy for hepatocellular carcinoma.
Despite advances in surgical technique and medical care, liver resection for hepatocellular carcinoma (HCC) remains a high-risk major operation. The present study evaluated the risk factors for early mortality after hepatectomy.We retrospectively reviewed records of patients undergoing liver resection for HCC between 1983 and 2015. A point score (Risk Assessment for early Mortality (RAM) score) for hepatectomy was developed based on multivariate analyses.Three hundred eighty-three patients (11.3%) expired within 6 months after the operation. Logistic regression analyses identified that operative duration >270 minutes and blood loss >800 cc were significant predictors of major surgical complications (P = 0.013 and 0.002, respectively). On the other hand, diabetes mellitus, albumin ≤3.5 g/dL, α-fetoprotein (AFP) >200 ng/mL, major surgical procedure, blood loss >800 cc, and major surgical complications were independent risk factors for early mortality after hepatectomy (P = 0.019, <0.001, <0.001, 0.006, 0.018, and <0.001, respectively). Risk Assessment for early Mortality score (RAM score) identified 3 subgroups of patients with distinct 6-month mortality rate, with Class III (score 10) having highest risk of early mortality.Our study demonstrated that meticulous surgical techniques to minimize blood loss and avoid prolonged operative time may help decrease the occurrence of major surgical complications. In addition to major surgical complications, diabetes mellitus, hypoalbuminemia, high AFP, massive blood loss, and major surgical procedure are also associated with early mortality after liver resection. Further study is warranted to validate the utility of RAM score as a bedside scoring system to predict postoperative outcome.
aDepartment of Surgery, Chang Gung Memorial Hospital, Linkou bCollege of Medicine, Chang Gung University, Guishan, Taoyuan cGraduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan dDepartment of Anesthesiology,Chang Gung Memorial Hospital, Linkou eDepartment of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan (R.O.C.).
Chao-Wei
CW
Lee
Hsin-I
HI
Tsai
Chang-Mu
CM
Sung
Chun-Wei
CW
Chen
Shu-Wei
SW
Huang
Wen-Juei
WJ
Jeng
Tsung-Han
TH
Wu
Kun-Ming
KM
Chan
Ming-Chin
MC
Yu
Wei-Chen
WC
Lee
Miin-Fu
MF
Chen
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
Ann Surg. 1995 Mar;221(3):291-8
7717783
World J Gastroenterol. 2014 May 28;20(20):6006-12
24876723
Gut. 1971 Mar;12(3):212-7
4324038
Br J Surg. 1990 Jun;77(6):677-80
2166610
Am J Infect Control. 1985 Jun;13(3):97-108
3849273
Arch Pathol Lab Med. 1994 Apr;118(4):371-9
8166587
Chin J Cancer. 2016 Mar 18;35:28
26992891
Br J Surg. 1997 Sep;84(9):1255-9
9313707
Ann Surg. 1978 Sep;188(3):363-71
80163
J Hepatobiliary Pancreat Sci. 2012 Jan;19(1):3-8
21938411
HPB (Oxford). 2002;4(2):99; author reply 99-100
18332933
Surg Gynecol Obstet. 1988 Jun;166(6):503-10
2836959
J Hepatobiliary Pancreat Surg. 1998;5(3):286-91
9880776
Hepatogastroenterology. 2007 Jan-Feb;54(73):186-9
17419257
Hepatobiliary Pancreat Dis Int. 2005 Aug;4(3):370-4
16109518
Ann Surg. 2009 Jun;249(6):995-1002
19474679
Oncol Lett. 2015 Feb;9(2):527-534
25624883
CA Cancer J Clin. 2015 Mar;65(2):87-108
25651787
J Am Coll Surg. 2000 Jul;191(1):38-46
10898182
Ann Surg. 1999 Mar;229(3):322-30
10077043
World J Surg. 2011 Sep;35(9):2073-82
21656309
Ann Surg. 2004 Aug;240(2):205-13
15273542
Ann Surg. 1997 Dec;226(6):704-11; discussion 711-3
9409569
World J Surg. 1986 Apr;10(2):311-7
3010585
World J Gastroenterol. 2010 Jun 21;16(23):2931-42
20556841
Int J Hepatol. 2011;2011:416459
21994855
World J Gastroenterol. 2014 Oct 28;20(40):14921-6
25356052
Ann Surg. 1983 Apr;197(4):375-88
6299217
Ann Surg. 1999 Feb;229(2):210-5
10024102
Arch Surg. 1999 Oct;134(10):1124-30
10522859
J Am Coll Surg. 2007 Apr;204(4):580-7
17382216
Br J Surg. 1999 Aug;86(8):1012-7
10460635
Br J Surg. 2003 Jan;90(1):33-41
12520572