Clinical Studies Of Perioperative Antiviral Therapy Reducing The Complications After Limited Resection Of Large Hepatocelluar Carcinoma

Objective Hepatectomies may exacerbate chronic hepatitis B in patients with highhepatitis B viral (HBV) DNA levels, and could result in hepatic insufficiency. Antiviraltreatment is effective for suppressing HBV virus loads. This study investigated whetherperioperative antiviral therapy is warranted for resection of hepatocellular carcinoma (HCC)with concurrent HBV infections.Methods Patients with HBV-related HCC (n=112) who underwent major liverresection were retrospectively divided into two groups based on treatment withperioperative antiviral therapy (antiviral group)(n=72) or absence of treatment (untreatedcontrols)(n=40).Results Exacerbation of chronic hepatitis B occurred in6untreated control patients(15.0%). The prevalence of hepatic insufficiency in the antiviral group and untreatedcontrol groups were1.4%(1/72) and12.5%(5/40), respectively (p <0.05). Five of them(4.5%) developed hepatic encephalopathy and3of them (2.7%) developed hepatorenalsyndrome. Untreated controls had significantly higher morbidity (75.0%vs.34.7%, p <0.01) than the antiviral group. Multivariate analysis demonstrated that G3-4S1-4staging,preoperative HBV DNA＞104copies/ml, and untreated controls were independent factorsfor morbidity due to liver-related complications. Untreated controls had significantly higherlevels of postoperative alanine aminotransferase (ALT) and serum bilirubin than did theantiviral therapy group. HBV-DNA levels in the untreated controls were significant higher than for the antiviral group on postoperative days7and30. Patients with G3-4S1-4staginghad a similar trend in postoperative liver function and HBV-DNA levels were observed asfor the whole groups of patients.Conclusion Perioperative antiviral treatment improves patient safety by decreasingmorbidity and speeding recovery of postoperative liver function for HBV-related majorHCC resection. All HBV-related HCC patients with HBV DNA levels＞104copies/mlshould receive antiviral therapy before hepatectomy.