Chok K S, Ng K K, Poon R T, Lo C M, Fan S T
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
Br J Surg. 2009 Jan;96(1):81-7. doi: 10.1002/bjs.6358.
The aim of this retrospective study was to determine the impact of postoperative complications on the long-term outcome of curative liver resection for hepatocellular carcinoma (HCC).
A total of 863 patients who had curative resection of HCC from December 1989 to December 2004 were included in the analysis. Median follow-up was 35.6 months.
Some 288 patients (33.4 per cent) developed postoperative complications. The hospital mortality rate was 5.3 per cent (46 patients). Multiple logistic regression analysis showed that older age and massive intraoperative blood loss were related to a significantly higher complication rate. Demographics of patients with and without postoperative complications were comparable. The former had significantly more blood loss (median 1.1 versus 0.7 litres; P < 0.001) and required more transfused blood (P < 0.001). The overall survival rates of patients without complications at 1, 3, 5 and 10 years were 83.6, 62.8, 51.5 and 32.1 per cent respectively. Corresponding rates for those with complications were 67.8, 52.4, 41.5 and 26.6 per cent (P = 0.004). Cox proportional hazard model analysis revealed that the presence of postoperative complications was independently associated with poor overall survival.
Postoperative complications can affect overall long-term survival after resection of HCC.
本回顾性研究旨在确定术后并发症对肝细胞癌（HCC）根治性肝切除长期预后的影响。
分析了1989年12月至2004年12月期间共863例行HCC根治性切除的患者。中位随访时间为35.6个月。
约288例患者（33.4%）发生了术后并发症。医院死亡率为5.3%（46例患者）。多因素logistic回归分析显示，年龄较大和术中大量失血与显著更高的并发症发生率相关。有和无术后并发症患者的人口统计学特征具有可比性。前者失血明显更多（中位数1.1升对0.7升；P<0.001），需要更多的输血（P<0.001）。无并发症患者1年、3年、5年和10年的总生存率分别为83.6%、62.8%、51.5%和32.1%。有并发症患者的相应比率分别为67.8%、52.4%、41.5%和26.6%（P=0.004）。Cox比例风险模型分析显示，术后并发症的存在与总体生存率差独立相关。
术后并发症会影响HCC切除术后的总体长期生存。
