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Postoperative morbidity adversely impacts long-term oncologic prognosis following hepatectomy for hepatocellular carcinoma: A multicenter observational study.

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机构: [a]Department of Hepatobiliary Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China [b]Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin Medical University, Harbin, Heilongjiang, China [c]Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China [d]School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China [e]Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Navy Medical University, Shanghai, China [f]The Second Department of Hepatobiliary Surgery, Meizhou People's Hospital, Meizhou, Guangdong, China [g]Department of Hepatic Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China [h]Department of General Surgery, Liuyang People's Hospital, Liuyang, Hunan, China [i]Department of Hepatobiliary Surgery, Pu'er People's Hospital, Pu'er, Yunnan, China [j]The First Department of General Surgery, the Fourth Hospital of Harbin, Harbin, Heilongjiang, China [k]Department of General Surgery, Ziyang First People's Hospital, Ziyang, Sichuan, China [l]Department of Hepatobiliary Surgery, Fuyang People's Hospital, Fuyang, Anhui, China [m]Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
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Postoperative morbidity following hepatectomy for hepatocellular carcinoma (HCC) is common and its impact on long-term oncological outcome remains unclear. This study aimed to investigate if postoperative morbidity impacts long-term survival and recurrence following hepatectomy for HCC. The data from a multicenter Chinese database of curative-intent hepatectomy for HCC were analyzed, and independent risks of postoperative 30-day morbidity were identified. After excluding patients with postoperative early deaths (≤90 days), early (≤2 years) and late (>2 years) recurrence rates, overall survival (OS), and time-to-recurrence (TTR) were compared between patients with and without postoperative morbidity. Among 2,161 patients eligible for the study, 758 (35.1%) had postoperative 30-day morbidity. Multivariable logistic regression analysis showed that diabetes mellitus, obesity, Child-Pugh grade B, cirrhosis, and intraoperative blood transfusion were independent risks of postoperative morbidity. The rates of early and late recurrence among patients with postoperative morbidity were higher than those without (50.7% vs. 38.8%, P < 0.001; and 41.7% vs. 34.1%, P = 0.017). Postoperative morbidity was associated with decreased OS (median: 48.1 vs. 91.6 months, P < 0.001) and TTR (median: 19.8 vs. 46.1 months; P < 0.001). After adjustment of confounding factors, multivariable Cox-regression analyses revealed that postoperative morbidity was associated with a 27.8% and 18.7% greater likelihood of mortality (hazard ratio 1.278; 95% confidence interval: 1.126-1.451; P < 0.001) and recurrence (1.187; 1.058-1.331; P = 0.004). This large multicenter study provides strong evidence that postoperative morbidity adversely impacts long-term oncologic prognosis after hepatectomy for HCC. The prevention and management of postoperative morbidity may be oncologically important. Copyright © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

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出版当年[2021]版:
大类 | 3 区 医学
小类 | 2 区 外科 3 区 肿瘤学
最新[2025]版:
大类 | 2 区 医学
小类 | 2 区 肿瘤学 2 区 外科
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出版当年[2020]版:
Q1 SURGERY Q2 ONCOLOGY
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Q1 SURGERY Q2 ONCOLOGY

影响因子: 最新[2023版] 最新五年平均 出版当年[2020版] 出版当年五年平均 出版前一年[2019版] 出版后一年[2021版]

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第一作者机构: [a]Department of Hepatobiliary Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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通讯机构: [c]Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China [e]Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Navy Medical University, Shanghai, China [*1]Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), No. 225, Changhai Road, Shanghai, 200438, China [*2]School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China. [*3]Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), No. 225, Changhai Road, Shanghai, 200438, China
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