Published online Jul 27, 2022. doi: 10.4240/wjgs.v14.i7.670
Peer-review started: January 30, 2022
First decision: March 12, 2022
Revised: March 28, 2022
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: July 27, 2022
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, on the other hand, the number of patients with chronic kidney disease (CKD) is on the rise because of the increase in lifestyle-related diseases.
To establish a tailored management strategy for HCC patients with CKD.
To evaluate the impact of comorbid renal dysfunction (RD), as stratified by using the estimated glomerular filtration rate (EGFR), and assessed the oncologic validity of hepatectomy for HCC patients with RD.
We enrolled 800 HCC patients who underwent hepatectomy between 1997 and 2015 at our university hospital. We categorized patients into two and three groups according to renal function as defined by the EGFR. Overall survival (OS) and recurrence-free survival (RFS) were compared among these groups and we also analyzed survival by using a propensity score matching (PSM) model to exclude the influence of patient characteristics.
The RD patients were significantly older and had lower serum total bilirubin, aspartate aminotransferase, and aspartate aminotransferase levels than the non-RD patients, and no patient received maintenance hemodialysis after surgery. Although the overall postoperative complication rates were similar between the RD and non-RD patients, the proportions of postoperative bleeding and surgical site infection were significantly higher in the RD patients, and postoperative bleeding was the highest in the severe CKD group. Regardless of the degree of comorbid RD, OS and RFS were comparable, even after PSM between the RD and non-RD groups to exclude the influence of patient characteristics, liver function, and other causes of death.
Comorbid mild RD had a negligible impact on the prognosis of HCC patients who underwent curative hepatectomy with appropriate perioperative management, and close attention to severe CKD is necessary to prevent postoperative bleeding and surgical site infection.
The present study will be useful for management of HCC patients with CKD in future.