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Published on: September 30, 2021
Risk factors for major morbidity after hepatectomy for hepatocellular carcinoma in 293 recent cases
Hiroshi Sadamori1, Takahito Yagi, Hiroaki Matsuda
1Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine and Dentistry, 2-5-1 Shikata, Okayama, 700-8558, Japan. sada@md.okayama-u.ac.jp
Insights
Prolonged operative time increases bile leakage risk after liver cancer surgery (hepatectomy). Repeat hepatectomy is a risk factor for intraabdominal abscesses following hepatocellular carcinoma (HCC) treatment.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Gastroenterology
Background:
- Hepatocellular carcinoma (HCC) is a common primary liver malignancy.
- Hepatectomy remains a primary curative treatment for HCC.
- Identifying complications after hepatectomy is crucial for patient outcomes.
Purpose of the Study:
- To identify risk factors for major morbidity after hepatectomy for HCC.
- To analyze the incidence and causes of bile leakage and intraabdominal abscess.
- To provide insights for improving surgical safety in HCC treatment.
Main Methods:
- Retrospective analysis of 293 patients undergoing hepatectomy for HCC (2001-2008).
- Univariate and multivariate analyses were performed to identify risk factors.
- Specific focus on operative time, repeat hepatectomy, bile leakage, and intraabdominal abscess.
Main Results:
- Bile leakage occurred in 12.9% of patients; operative time >= 300 minutes was a significant risk factor (OR=4.9).
- Intraabdominal abscess occurred in 9.2% of patients; repeat hepatectomy was a significant risk factor (OR=5.3).
- Preoperative biliary strictures and MRSA were identified as key contributors to complications.
Conclusions:
- Prolonged operative time and repeat hepatectomy are independent risk factors for bile leakage and intraabdominal abscess, respectively.
- Preoperative biliary anatomy assessment is recommended for patients with prior HCC treatments.
- Strategies to mitigate these risks can improve outcomes after HCC hepatectomy.
Background/Purpose:
The purpose of this study was to identify risk factors for major morbidity after hepatectomies for hepatocellular carcinoma (HCC).
Methods:
Univariate and multivariate analyses of risk factors for major morbidity were performed in 293 patients who underwent hepatectomy for HCC between 2001 and 2008.
Results:
Two hundred and forty-three patients (82.9%) underwent an anatomic hepatectomy, and a repeat hepatectomy was performed in 50 patients (17.1%). The prevalences of bile leakage and intraabdominal abscess were 12.9% and 9.2%, respectively. The risk factor for bile leakage was an operative time >or= 300 min and the risk factor for intraabdominal abscess was a repeat hepatectomy (odds ratios = 4.9 and 5.3, respectively). The main cause of bile leakage that made endoscopic therapy or percutaneous transhepatic biliary drainage necessary was a latent stricture of the biliary anatomy that had existed preoperatively, caused by previous treatments for HCC. Methicillin-resistant Staphylococcus aureus was the main causative bacteria of intraabdominal abscess after repeat hepatectomies.
Conclusions:
Our recent series revealed that prolonged operative time and repeat hepatectomy were independent risk factors for bile leakage and intraabdominal abscess, respectively, after hepatectomies for HCC. Preoperative assessment of the biliary anatomy should be considered for patients who have had previous multiple treatments for HCC, including hepatectomy, to reduce bile leakage that makes invasive treatment necessary.
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