Comparisons Of Perioperative Complications And Their Risk Factors Between Cirrhotic And Noncirrhotic Patients With Hepatocellular Carcinoma

ObjectiveTo compare the difference during the procedure and perioperative complications between cirrhotic and noncirrhotic HCC patients with HBsAg positive,and then investigate the prognostic factors for perioperative liver failure and death,respectively.MethodsWe retrospectively collected the clinical data of HCC patients with HBs Ag positive who were performed hepatectomy from January 2008 to December 2012 in Southwest Hospital of Third Military Medical University.According to the postoperative pathological examination results indicated that the presence or absence of liver cirrhosis,all the HCC patients were divided into 2 groups: the cirrhosis group(633 cases)and the noncirrhosis group(450 cases).Count data were compared using ?2 test or Fisher's exact test;measurement data with normal distribution were compared using T test;measurement data with skewed distribution were compared using Mann-Whitney U test.The operation conditions(intraoperative bleeding volume,rate of blood transfusion,operation time,rate of pringle maneuver)and perioperative complications were compared between the two groups.Univariate analysis was performed by ?2 test and multivariate analysis was performed by Logistic regression model to screen and analyze the prognostic factors for perioperative liver failure and death,respectively.Results1.Operation conditionsThe intraoperative bleeding volume in cirrhosis group was obviously higher than that in the noncirrhosis group(500 mL vs 400 m L,P=0.027),and there was a significant difference between them.There were no significant differences in the rate of blood transfusion(29.9% vs 27.1%,P=0.325),the operation time(250 min vs 242 min,P=0.226)and the rate of pringle maneuver(62.2% vs 66.7%,P=0.135)between the 2 groups.2.Complications conditionsThe incidence of perioperative complications in cirrhosis group was significantly higher than that in noncirrhosis group(30.5% vs 21.1%,P=0.001),and there was a significant difference between them.The incidence of pulmonary infection(6.5% vs 3.6%,P=0.034),abdominal infection(2.7% vs 0.9%,P=0.035),liver failure(5.5% vs 1.3%,P=0.000)and death(5.9% vs 2.4%,P=0.007)in cirrhosis group were obviously higher than that in the noncirrhosis group among the perioperative complications,and there were statistically significant differences between them;however,there were no significant differences in the incidence of incision infection(4.7% vs 3.8%,P=0.444),pleural effusion(11.1% vs 7.6%,P=0.054),respiratory failure(1.7% vs 0.9%,P=0.239),ascites(4.6% vs 6.7%,P=0.136),intraabdominal bleeding(1.0% vs 0.4%,P=0.553),Bile leakage(5.5% vs 5.3%,P=0.889),renal failure(1.1% vs 0.2%,P=0.189),septicemia(0.6% vs 0.4%,P=1.000)between the 2 groups.In addition,average postoperative hospitalization time in cirrhosis group was obviously longer than that in noncirrhosis group(16.8±8.2 d vs 15.6±7.0 d,P=0.009),and there was a significant difference between them,too.3.Risk factors for perioperative liver failureUnivariate analysis showed that age(P=0.025),AST(P=0.005),ALB(P=0.003),Child-Pugh classification(P=0.000),intraoperative bleeding volume(P=0.002),blood transfusion(P=0.000),operation time(P=0.000),the extent of liver resection(P=0.001),tumor diameter(P=0.019),liver cirrhosis(P=0.000)were associated with perioperative liver failure in all the HCC patients;age(P=0.015),AST(P=0.020),ALB(P=0.001),Child-Pugh classification(P=0.000),blood transfusion(P=0.000),operation time(P=0.003),extent of liver resection(P=0.000),tumor diameter(P=0.016)were associated with perioperative liver failure in cirrhotic patients perioperative liver failure;intraoperative bleeding volume(P=0.003)were associated with perioperative liver failure in noncirrhotic patients.Multivariate analysis showed that age ? 60 years(OR=2.285,95%CI: 1.081-4.831,P=0.030),Child-Pugh class B(OR=2.716,95%CI: 1.100-6.706,P=0.030),blood transfusion(OR=2.159,95%CI: 1.068-4.362,P=0.032),operation time > 360min(OR=2.315,95%CI: 1.064-5.038,P=0.034),liver resection ? 3 segments(OR=2.459,95%CI: 1.264-4.786,P=0.008),liver cirrhosis(OR=4.322,95%CI: 1.763-10.598,P=0.001)were independent risk factors for perioperative liver failure in all the HCC patients;ALB < 38g/L(OR=2.231,95%CI: 1.038-4.795,P=0.040),Child-Pugh class B(OR=2.857,95%CI: 1.095-7.451,P=0.032),blood transfusion(OR=2.186,95%CI: 1.045-4.576,P=0.038),liver resection ? 3 segments(OR=2.927,95%CI: 1.426-6.008,P=0.003)were independent risk factors for perioperative liver failure in cirrhotic patients;intraoperative bleeding volume > 1200 m L(OR=15.077,95%CI: 2.695-84.353,P=0.002)was the only independent risk factor for perioperative liver failure in noncirrhotic patients.4.Risk factors for perioperative deathUnivariate analysis showed that gender(P=0.035),ALB(P=0.003),TBIL(P=0.040),Child-Pugh classification(P=0.027),blood transfusion(P=0.007),extent of liver resection(P=0.001),tumor diameter(P=0.009),tumor thrombus(P=0.038),liver cirrhosis(P=0.007)were associated with perioperative death in all the HCC patients;ALB(P=0.000),extent of liver resection(P=0.000),tumor diameter(P=0.001)were associated with perioperative death in cirrhotic patients;blood transfusion(P=0.016),tumor thrombus(P=0.011)were associated with perioperative death in noncirrhotic patients.Multivariate analysis showed that ALB < 38g/L(OR=2.560,95%CI: 1.382-4.742,P=0.003),liver resection ? 3 segments(OR=2.657,95%CI: 1.471-4.800,P=0.001),liver cirrhosis(OR=2.567,95%CI: 1.283-5.134,P=0.008)were independent risk factors for perioperative death in all the HCC patients;ALB < 38g/L(OR=3.003,95%CI: 1.495-6.034,P=0.002),liver resection ? 3 segments(OR=2.533,95%CI: 1.251-5.128,P=0.010),tumor diameter ?5 cm(OR=3.060,95%CI: 1.135-8.251,P=0.027)were independent risk factors for perioperative death in cirrhotic patients;blood transfusion(OR=3.755,95%CI: 1.047-13.467,P=0.042),tumor thrombus(OR=4.036,95%CI: 1.126-14.469,P=0.032)were independent risk factors for perioperative death in noncirrhotic patients.Conclusions1.The intraoperative bleeding volume in cirrhotic HCC patients was significantly higher than that in noncirrhotic HCC patients;there were no significant differences in the rate of blood transfusion,the operation time and the rate of pringle maneuver between cirrhotic HCC patients and noncirrhotic HCC patients.2.The incidence of perioperative complications in cirrhotic HCC patients was significantly higher than that in noncirrhotic HCC patients,especially in pulmonary infection,abdominal infection,liver failure and death.3.Liver cirrhosis is an independent risk factor for perioperative liver failure and death in HCC patients.The risk factors for perioperative liver failure and death were different between cirrhotic HCC patients and noncirrhotic HCC patients.4.The risk factors that affecting perioperative liver failure or death are different between cirrhotic HCC patients and noncirrhotic HCC patients.Compared with the noncirrhotic HCC patients,the cirrhotic HCC patients are prone to be affected by preoperative serum albumin level,extent of liver resection and tumor diameter.