Survival outcomes of hepatocellular carcinoma resection with postoperative complications - a propensity-score-matched analysis.
Curative resection remains the only hope of cure for hepatocellular carcinoma (HCC), but postoperative complications can have a significant impact on long-term survival. However, only scarce data on such impact can be found in the literature.This retrospective study reviewed the prospectively collected data of patients who underwent primary liver resection for HCC at our hospital during the period from December 1989 to December 2014. Patients with and without postoperative complications were compared. A 1:1 propensity score matching was adopted by matching age, comorbidity, Model of End-stage Liver Disease score, tumor stage, and extent of resection.Totally 1710 patients were eligible for the study. Four hundred and sixty-one (27.0%) of them developed postoperative complications while 1249 (73.0%) did not. After propensity score matching, 922 patients were compared in a 1:1 ratio (461 with postoperative complications and 461 without). Patients who developed postoperative complications were demographically similar to patients who did not, but had more intraoperative blood loss and transfusion (both P < 0.001), longer hospital stay (17 vs 9 days; P < 0.001), worse hospital mortality (12.1% vs 0%; P < 0.001), and shorter overall survival (P < 0.001). On multivariate analysis, factors that might have affected overall survival were cancer stage (HR 1.22, P < 0.001), tumor size (HR 1.02, P = 0.005), tumor number (HR 1.08, P < 0.001), venous invasion (HR 1.38, P = 0.003), extent of resection (HR 1.19, P = 0.045), intraoperative blood loss (HR 1.11, P < 0.001), postoperative complication (HR 1.37, P < 0.001), and era effect (HR 1.27, P = 0.01).Patients should be monitored closely after HCC resection. Prompt treatment of postoperative complications may be salvational.
Department of Surgery, The University of Hong Kong Department of Surgery, Queen Mary Hospital State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China.
Kenneth S H
KSH
Chok
Millies M Y
MMY
Chan
Wing Chiu
WC
Dai
Albert C Y
ACY
Chan
Tan To
TT
Cheung
Tiffany C L
TCL
Wong
Wong Hoi
WH
She
Chung Mau
CM
Lo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006498:Hepatectomy / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D057216:Propensity Score; D012189:Retrospective Studies; D047368:Tumor Burden; D055815:Young Adult