Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
HPB (Oxford). 2012 May;14(5):317-24. doi: 10.1111/j.1477-2574.2012.00452.x.
There are few reports on the efficacy of hepatectomy for hepatocellular carcinoma (HCC) in patients with renal dysfunction (RD). This study aimed to clarify the validity of hepatectomy for treating HCC in RD patients, and to compare postoperative courses in RD and non-RD patients.
The clinical features of 722 HCC patients who underwent curative hepatectomy between 1986 and 2009 were retrospectively reviewed. Seventeen patients (2.4%) with preoperative serum creatinine levels of >2.0 mg/dl were defined as the RD group, and, of these, seven who did not receive preoperative haemodialysis were defined as borderline patients. Clinicopathological characteristics and postoperative outcomes were compared between the RD group (n= 17) and the non-RD group (n= 705). The postoperative courses of borderline patients were reviewed in detail.
Overall survival (P= 0.177) and disease-free survival (P= 0.942) after hepatectomy did not differ significantly between the groups. Incidences of massive ascites (35.3% vs. 14.3%; P= 0.034) and pleural effusion (52.9% vs. 17.6%; P= 0.001), defined as massive effusion (ME), were significantly higher in the RD group than in the non-RD group. Hypoalbuminaemia (≤2.8 g/dl; P= 0.031), heavy blood loss (≥1000 ml; P= 0.012) and intraoperative blood transfusion (P= 0.007) were risk factors for ME. Among the borderline patients, serum creatinine values were not increased immediately after surgery and four patients underwent haemodialysis.
Preoperative hypoalbuminaemia, heavy blood loss and blood transfusion are independent risk factors for ME in RD patients. Preoperative improvement of anaemia and reduction of blood loss by meticulous surgical techniques may prevent ME in RD patients who require hepatectomy for HCC.
肾功能不全（RD）患者肝细胞癌（HCC）行肝切除术的疗效鲜有报道。本研究旨在阐明 RD 患者行肝切除术治疗 HCC 的有效性，并比较 RD 患者与非 RD 患者的术后过程。
回顾性分析 1986 年至 2009 年间接受根治性肝切除术的 722 例 HCC 患者的临床资料。将术前血清肌酐水平＞2.0mg/dl 的 17 例患者（2.4%）定义为 RD 组，其中 7 例未行术前血液透析的患者定义为边缘患者。比较 RD 组（n=17）与非 RD 组（n=705）的临床病理特征和术后结果。详细回顾边缘患者的术后过程。
两组患者的肝切除术后总生存（P=0.177）和无病生存（P=0.942）无显著差异。RD 组大量腹水（35.3%比 14.3%；P=0.034）和胸腔积液（52.9%比 17.6%；P=0.001）的发生率显著高于非 RD 组，定义为大量渗出（ME）。低蛋白血症（≤2.8g/dl；P=0.031）、大量失血（≥1000ml；P=0.012）和术中输血（P=0.007）是 ME 的危险因素。在边缘患者中，术后血清肌酐值并未立即升高，有 4 例患者接受了血液透析。
术前低蛋白血症、大量失血和输血是 RD 患者 ME 的独立危险因素。通过精细的手术技术术前改善贫血和减少失血可能预防需要肝切除术治疗 HCC 的 RD 患者发生 ME。
