Clinical impact of underlying end-stage renal disease in patients undergoing resection for hepatic malignancy

The clinical influence of end-stage renal disease (ESRD) in patients undergoing hepatectomy for malignancy remains to be fully understood.

Outcomes of patients receiving hemodialysis (HD) at the time of surgery (HD group; n = 29) and those who were not (non-HD group; n = 2008) were compared using a clinical dataset of patients undergoing surgery for hepatic malignancies.

Multivariate analysis confirmed that the risk of blood loss > 1000 mL (odds ratio [OR], 3.02), the need for blood transfusion (OR, 4.53), the risk of any postoperative complications (OR, 2.55), the risk of major postoperative complications (OR, 4.03), and 90-day mortality (OR, 19.00) were higher in patients who were on HD. Patients in the HD group also showed a tendency toward worse survival, with the major cause of death classified as noncancer-related death. Competing-risks regression analysis showed that ESRD on HD was associated with noncancer-related death (hazard ratio, 5.19), whereas it was not correlated with an increased risk of cancer-specific mortality.

Hepatectomy for malignancies in patients undergoing HD was associated with an increased risk of perioperative morbidity and mortality. Although ESRD/HD was not significantly associated with increased cancer-specific mortality in our limited cohort, the poorer survival observed among patients with ESRD was mainly attributable to noncancer-related death.