Elshaarawy O, Aman A, Zakaria HM, Zakareya T, Gomaa A, Elshimi E, Abdelsameea E. Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis. World J Gastrointest Oncol 2021; 13(5): 424-439 [PMID: 34040703 DOI: 10.4251/wjgo.v13.i5.424]
Corresponding Author of This Article
Esam Elshimi, MBChB, MD, MSc, Doctor, Full Professor, Department of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Yassin Abdelghaffar Street, Shebine Elkom 32511, Menoufia, Egypt. eelshimi@liver-eg.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. May 15, 2021; 13(5): 424-439 Published online May 15, 2021. doi: 10.4251/wjgo.v13.i5.424
Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis
Omar Elshaarawy, Aya Aman, Hazem Mohamed Zakaria, Talaat Zakareya, Asmaa Gomaa, Esam Elshimi, Eman Abdelsameea
Omar Elshaarawy, Aya Aman, Talaat Zakareya, Asmaa Gomaa, Esam Elshimi, Eman Abdelsameea, Department of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Shebine Elkom 32511, Menoufia, Egypt
Hazem Mohamed Zakaria, Department of Hepatobiliary Pancreatic Surgery, National Liver Institute, Menoufia University, Shebine Elkom 32511, Menoufia, Egypt
Author contributions: Abdelsameea E and Elshimi E performed the study concept and design; all authors performed the data collection, revision and preparing the manuscript, and wrote the final manuscript.
Institutional review board statement: The study protocol was approved by the ethics committee (for medical research) in accordance with the Declaration of Helsinki and by the Institutional Review Board of the National Liver Institute, Menoufia University-Egypt, February 2017, No. IRB00003413.
Informed consent statement: Written informed consent was obtained from each patient included in the study.
Conflict-of-interest statement: All authors have no conflict of interests.
Data sharing statement: We have no additional data to be shared.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Esam Elshimi, MBChB, MD, MSc, Doctor, Full Professor, Department of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Yassin Abdelghaffar Street, Shebine Elkom 32511, Menoufia, Egypt. eelshimi@liver-eg.org
Received: January 6, 2021 Peer-review started: January 6, 2021 First decision: January 25, 2021 Revised: February 11, 2021 Accepted: April 22, 2021 Article in press: April 22, 2021 Published online: May 15, 2021 Processing time: 120 Days and 16 Hours
Abstract
BACKGROUND
Given the poor synthetic function of cirrhotic liver, successful resection for patients with hepatocellular carcinoma (HCC) necessitates the ability to achieve resections with tumor free margins.
AIM
To validate post hepatectomy liver failure score (PHLF), compare it to other established systems and to stratify risks in patients with cirrhosis who underwent curative liver resection for HCC.
METHODS
Between December 2010 and January 2017, 120 patients underwent curative resection for HCC in patients with cirrhosis were included, the pre-operative, operative and post-operative factors were recorded to stratify patients' risks of decompensation, survival, and PHLF.
RESULTS
The preoperative model for end-stage liver disease (MELD) score [odds ratio (OR) = 2.7, 95%CI: 1.2-5.7, P = 0.013], tumor diameter (OR = 5.4, 95%CI: 2-14.8, P = 0.001) and duration of hospital stay (OR = 2.5, 95%CI: 1.5-4.2, P = 0.001) were significant independent predictors of hepatic decompensation after resection. While the preoperative MELD score [hazard ratio (HR) = 1.37, 95%CI: 1.16-1.62, P < 0.001] and different grades of PHLF (grade A: HR = 2.33, 95%CI: 0.59-9.24; Grade B: HR = 3.15, 95%CI: 1.11-8.95; Grade C: HR = 373.41, 95%CI: 66.23-2105.43; P < 0.001) and HCC recurrence (HR = 11.67, 95%CI: 4.19-32.52, P < 0.001) were significant independent predictors for survival.
CONCLUSION
Preoperative MELD score and tumor diameter can independently predict hepatic decompensation. While, preoperative MELD score, different grades of PHLF and HCC recurrence can precisely predict survival.
Core Tip: The present study clearly confirmed that, in patients with cirrhosis who underwent curative resection for hepatocellular carcinoma (HCC), the preoperative model for end-stage liver disease (MELD) score, tumor diameter and the duration of hospital stay were independent predictors of decompensation. While, preoperative MELD score, different grades of post hepatectomy liver failure score and HCC recurrence were independent predictors for survival.
