title: Complications after Hepatectomy for Hepatocellular Carcinoma Independently Shorten Survival: A Western, Single-Center Audit.
abstract: BACKGROUND
  The impact of postoperative complications (POCs) on long-term outcomes following hepatocellular carcinoma (HCC) resection remains to be ascertained.
  
  
  METHODS
  All consecutive HCC resected at a single center were analyzed. Patients with POCs, classified according to Clavien classification, were compared to those without in terms of demographics, pathology, management, overall survival (OS), and disease-free survival (DFS). Independent prognostic factors of POCs were identified using multivariable regression models.
  
  
  RESULTS
  Among 341 patients, overall POCs rate was 34% (n = 116) and grade III-IV POCs rate was 14.4% (n = 49). POCs were an independent negative factor for OS [hazard ratio (HR) 1.40, 95% confidence interval (CI) 1.12-2.26, p = 0.009] with BCLC stage, the need for combined procedure, intraoperative transfusion, and the METAVIR score of the underlying parenchyma. Similarly, occurrence of POCs was associated independently with DFS (HR 1.59, 95% CI 1.18-2.15, p = 0.002), together with the presence of portal hypertension, BCLC stage, the need for combined procedure, intraoperative transfusion, and the presence of satellite nodules. After stratification, the negative impact of morbidity on OS and DFS reached statistical significance in the BCLC stage A subset only (p = 0.026, and p < 0.001, respectively). Open resection, intraoperative transfusion, and the existence of underlying liver injury were independent predictors of POCs.
  
  
  CONCLUSIONS
  POCs should be considered as a long-term prognostic factor. Careful patient selection requiring underlying liver assessment and appropriate strategy, such as mini-invasive surgery and restricted transfusion policy, might be promoted to prevent POCs.
authors.affiliation: Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, AP-HP, Créteil, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Doussot
authors.affiliation: Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, AP-HP, Créteil, France.
authors.forename: Chetana
authors.initials: C
authors.lastname: Lim
authors.affiliation: Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, AP-HP, Créteil, France.
authors.forename: Eylon
authors.initials: E
authors.lastname: Lahat
authors.affiliation: Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, AP-HP, Créteil, France.
authors.forename: Chady
authors.initials: C
authors.lastname: Salloum
authors.affiliation: Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, AP-HP, Créteil, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Osseis
authors.affiliation: Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, AP-HP, Créteil, France.
authors.forename: Concepción Gómez
authors.initials: CG
authors.lastname: Gavara
authors.affiliation: Department of Anesthesiology and Intensive Care, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, AP-HP, Créteil, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Levesque
authors.affiliation: Department of Hepatology, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, AP-HP, Créteil, France.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Feray
authors.affiliation: Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, AP-HP, Créteil, France.|INSERM 955, Créteil, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Compagnon
authors.affiliation: Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, AP-HP, Créteil, France. daniel.azoulay@aphp.fr.|INSERM 955, Créteil, France. daniel.azoulay@aphp.fr.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate