Predictors of quality-of-life following liver resection for malignancy

As cancer care increasingly prioritizes patient-centered outcomes, understanding predictors of postoperative quality of life (QOL) is essential. This study aimed to identify preoperative factors associated with early QOL outcomes following oncologic liver resection, using prospectively collected data from a multicenter randomized controlled trial.

This was a secondary analysis of the Hemorrhage During Liver Resection: Tranexamic Acid (HeLiX) trial (NCT02261415), conducted across 11 tertiary centers in Canada and the USA. Patients undergoing liver resection for malignancy completed the EORTC QLQ-C30 questionnaire preoperatively and at postoperative day (POD) 30. Multivariable regression was used to identify preoperative clinical and demographic predictors of clinically meaningful QOL changes across five domains. Inverse probability weighting addressed potential bias from missing data.

Of 863 eligible patients, 796 completed baseline and 588 completed POD30 QOL assessments. Lower preoperative QOL was consistently associated with worse postoperative scores. Major and multivisceral resections predicted clinically meaningful declines in physical, role, and global functioning. Female sex, cardiovascular comorbidities, and smoking were also associated with decline. Prior liver resection and biliary or vascular reconstruction were linked to better physical function at POD30.

Preoperative factors significantly influence early postoperative QOL. These findings support personalized risk counseling and proactive recovery planning in liver cancer surgery.