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Updated: Aug 5, 2026
Laparoscopic Anterior Right Hepatectomy: A Single-Center Experience
Published on: December 4, 2023
Underrecognized cardiovascular complications after hepatectomy: population-level mortality burden from a multicentre
Junlong Dai1,2,3, Zhancheng Qiu1, Jimmy Che-To Lai2,3,4,5
1Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Insights
Postoperative complications after liver cancer surgery significantly impact survival and hospital stay. Cardiovascular issues are key contributors to early mortality and long-term survival, distinct from liver-specific complications.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Critical Care Medicine
Background:
- Postoperative complications are critical determinants of outcomes following hepatectomy for hepatocellular carcinoma (HCC).
- The relationship between complications prolonging hospitalization and those contributing to mortality after HCC hepatectomy remains unclear.
Purpose of the Study:
- To investigate the distinct contributions of postoperative complications to 90-day mortality and prolonged hospital stay after hepatectomy for HCC.
- To identify specific complication types associated with long-term survival and recurrence-free survival following HCC resection.
Main Methods:
- A multicentre cohort study involving 1,883 patients undergoing curative-intent hepatectomy for HCC.
- Calculation of adjusted population-attributable fractions (PAFs) for various complication categories.
- Multivariable Cox models to assess associations with overall survival and recurrence-free survival.
Main Results:
- A divergence was observed between hospitalization burden and mortality burden.
- Liver surgery-specific complications had the largest burden on prolonged hospitalization (PAF 11.0%) and 90-day mortality (PAF 10.0%).
- Cardiovascular complications were the leading non-liver contributor to 90-day mortality (PAF 9.4%) and independently associated with worse overall survival.
Conclusions:
- Postoperative recovery burden and mortality burden are not interchangeable after hepatectomy for HCC.
- Cardiovascular complications are an underrecognized contributor to early mortality and worse long-term survival post-hepatectomy.
- An integrated perioperative framework with cardiovascular risk assessment may enhance risk prioritization.
Abstract:
Postoperative complications remain major determinants of outcomes after hepatectomy for hepatocellular carcinoma (HCC), but whether complications that prolong hospitalization are also those that contribute most to mortality remains unclear. This multicentre cohort study included 1,883 patients undergoing curative-intent hepatectomy for HCC across seven tertiary centers. Postoperative complications were categorized by organ system, and adjusted population-attributable fractions (PAFs) were calculated to estimate their contributions to 90-day mortality and prolonged hospital stay. Multivariable Cox models were used to assess associations with overall survival and recurrence-free survival. A divergence between hospitalization burden and mortality burden was observed. Liver surgery-specific complications accounted for the largest population-level burden of prolonged hospitalization (PAF 11.0%) and 90-day mortality (PAF 10.0%). Cardiovascular complications were the leading non-liver contributor to 90-day mortality (PAF 9.4%), despite a smaller contribution to prolonged hospitalization (PAF 4.1%). Pulmonary complications, cardiovascular complications, renal complications, and glucose dysregulation were independently associated with worse overall survival, whereas no complication domain was independently associated with recurrence-free survival. These findings show that postoperative recovery burden and mortality burden are not interchangeable after hepatectomy. Liver surgery-specific complications dominated hospitalization burden, whereas cardiovascular complications represented an underrecognized non-liver contributor to early mortality and worse long-term survival. An integrated perioperative framework incorporating systematic cardiovascular risk assessment may improve risk prioritization after hepatectomy for HCC.
