Risk Factors of Morbidity and Mortality Following Surgical Resection for Hepatocellular Carcinoma

Korean J Hepatol > Volume 10(1); 2004 > Article

The Korean Journal of Hepatology 2004;10(1): 51-61.

Risk Factors of Morbidity and Mortality Following Surgical Resection for Hepatocellular Carcinoma

Wan Wook Kim, M.D., Kwang-Woong Lee, M.D., Sung Ho Choi, M.D., Jin Seok Heo, M.D., Yong Il Kim, M.D., Sung Ju Kim, M.D., Dae Sung Lee, M.D., Hwan Hyo Lee, M.D., Seung Woon Paik, M.D.1, Kwang Cheol Koh, M.D.1, Joon Hyoek Lee, M.D.1, Moon Seok Choi, M.D.1 , Byung Chul Yoo, M.D.1 and Jae Won Joh, M.D.

Department of Surgery, and Division of Gastroenterology1, Samsung Medical Center, Sungkyunkwan University School of Medicine

ABSTRACT

Background/Aims
Recently, mortality following surgical resection for hepatocelluar carcinoma has been reduced significantly. Morbidity, however, is still significant. This study evaluated the risk factors leading to morbidity and mortality. Methods: 510 patients who had a hepatic resection form Nov. 1994 to Dec. 2001 were included. The patient demographics showed a mean age of 51.6 years with a male to female ratio of 4:1. The HBsAg was positive in 76.0% and the anti-HCV was positive in 8.2%. The mean tumor size was 5.2 cm, 26.2% of patients had preoperative transcatheter arterial embolization (TAE), and 8.7% had preoperative percutaneous transhepatic portal embolization (PTPE). Limited resection was performed in 259 cases (50.7%), and major resection was conducted in 251 cases (49.1%). Risk factors included age, sex, laboratory findings (liver function test, prothrombin time, albumin, glucose, α-fetoprotein, ICG test), preoperative TAE, PTPE, operation type, operation time, intraoperative transfusion, tumor size, and cirrhosis.
Results
The morbidity was 10.5% (54 cases). Operative death occurred in 5 cases (1.0%). Hospital death, including operative death, occurred in 6 cases (1.2%). Five cases were associated with hepatic failure and 1 case was associated with aspiration pneumonia accompanying hepatic failure. Transfusion (P=0.002), glucose (P=0.002), and prothrombin time (P=0.038) were significantly related to morbidity. Age (P=0.028), glucose (P=0.011), and TAE (P=0.046) were significantly related to mortality. Conclusions: Intraoperative transfusion, which is mainly related to intraoperative bleeding, should be reduced if possible to decrease morbidity. Diabetes mellitus patients and the elderly need careful perioperative management.(Korean J Hepatol 2004;10:51-61)

KeyWords: Hepatocelular carcinoma, Hepatectomy, Morbidity, Mortality, Risk factors