Published online Feb 26, 2020. doi: 10.12998/wjcc.v8.i4.713
Peer-review started: November 29, 2019
First decision: December 30, 2019
Revised: January 3, 2020
Accepted: February 12, 2020
Article in press: February 12, 2020
Published online: February 26, 2020
Processing time: 89 Days and 12.5 Hours
The risk factors for patients with major postoperative complications immediately after liver resection have been identified; however, the intermediate and long-term prognoses for these patients have yet to be determined.
The aim of the study was to evaluate the factors responsible for the long-term recurrence-free survival rate in patients with hepatocellular carcinoma (HCC) following anatomic hepatectomy.
We performed a retrospective analysis of 74 patients with HCC who underwent precise anatomic hepatectomy at our institution from January 2013 to December 2015. The observational endpoints for this study were the tumor recurrence or death of the HCC patients. The overall follow-up duration was 3 years. The recurrence-free survival curves were plotted by the Kaplan-Meier method and were analyzed by the log-rank test. The value of each variable for predicting prognosis was assessed via multivariate Cox proportional hazards regression analysis.
The 1-year and 3-year recurrence-free survival rates of HCC patients were 68.92% and 55.41%, respectively, following anatomic liver resection. The results showed that the 3-year recurrence-free survival rate in HCC patients was closely related to preoperative cirrhosis, jaundice level, tumor stage, maximal tumor diameter, complications of diabetes mellitus, frequency of intraoperative hypotensive episodes, estimated blood loss, blood transfusion, fluid infusion, and postoperative infection (P < 0.1). Based on multivariate analysis, preoperative cirrhosis, tumor stage, intraoperative hypotension, and estimated blood loss were identified to be predictors of 3-year recurrence-free survival in HCC patients undergoing anatomic hepatectomy (P < 0.05).
Tumor stage and preoperative cirrhosis adversely affect the postoperative recurrence-free survival rate in patients with hepatocellular carcinoma following anatomic hepatectomy. Furthermore, intraoperative hypotension and blood loss are the key determinants of long-term outcomes for HCC patients. Therefore, strict blood pressure control and reducing blood loss during surgery may improve the long-term prognosis of HCC patients following anatomic hepatectomy.
It is uncertain whether a different definition would have served as a better predictor of disease recurrence for these HCC patients. Therefore, a multicenter and large-sample, randomized, controlled trial is warranted to validate the findings of our study.