Postoperative morbidity adversely impacts long-term oncologic prognosis following hepatectomy for hepatocellular carcinoma: A multicenter observational study
Background & aims: 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. Methods: 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. Results: 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). Conclusion: 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. (C) 2021 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
基金：
National Science Foundation of China [81972726]; Open Fund of Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, China [GPKF202006]
第一作者单位：[1]Harbin Med Univ, Affiliated Hosp 1, Dept Hepatobiliary Surg, Harbin, Heilongjiang, Peoples R China[2]Harbin Med Univ, Minist Educ, Key Lab Hepatosplen Surg, Harbin, Heilongjiang, Peoples R China
通讯作者：
通讯机构：[3]Hangzhou Med Coll, Zhejiang Prov Peoples Hosp, Peoples Hosp, Dept Hepatobiliary Pancreat & Minimal Invas Surg, Hangzhou, Zhejiang, Peoples R China[4]Hangzhou Med Coll, Sch Clin Med, Hangzhou, Zhejiang, Peoples R China[5]Second Mil Med Univ, Navy Med Univ, Eastern Hepatobiliary Surg Hosp, Dept Hepatobiliary Surg, 225 Changhai Rd, Shanghai 200438, Peoples R China[13]Key Lab Tumor Mol Diag & Individualized Med Zheji, Hangzhou, Zhejiang, Peoples R China
推荐引用方式(GB/T 7714)：
Li Lin-Qiang,Liang Lei,Sun Li-Yang,et al.Postoperative morbidity adversely impacts long-term oncologic prognosis following hepatectomy for hepatocellular carcinoma: A multicenter observational study[J].EJSO.2021,47(10):2551-2560.doi:10.1016/j.ejso.2021.04.027.
APA：
Li, Lin-Qiang,Liang, Lei,Sun, Li-Yang,Li, Chao,Wu, Han...&Yang, Tian.(2021).Postoperative morbidity adversely impacts long-term oncologic prognosis following hepatectomy for hepatocellular carcinoma: A multicenter observational study.EJSO,47,(10)
MLA：
Li, Lin-Qiang,et al."Postoperative morbidity adversely impacts long-term oncologic prognosis following hepatectomy for hepatocellular carcinoma: A multicenter observational study".EJSO 47..10(2021):2551-2560
