Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8522, Japan.
World J Surg. 2021 Feb;45(2):598-606. doi: 10.1007/s00268-020-05829-z. Epub 2020 Oct 21.
The aim of this study was to clarify the feasibility of liver resection in hepatocellular carcinoma (HCC) patients with chronic kidney disease (CKD).
In all, 204 patients who underwent primary liver resection for HCC between 2011 and 2019 were analyzed. Short-term and long-term outcomes were compared between the CKD and control groups. The CKD group was defined by a preoperative estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73 m and chronic kidney disease Stage 3B or higher.
Twenty-eight patients (13.7%) had CKD. No significant differences were observed in the overall complication rates between the groups (46.4% vs. 34.7% p = 0.229). The incidence of bile leakage was significantly higher in the CKD group than in the control group (14.3% vs. 4.0% p = 0.048), and the median postoperative hospital stay was significantly longer in the CKD group (11 vs. 9 days p = 0.031). No significant differences were found in the disease-free survival between the two groups (p = 0.763), but overall survival (OS) was significantly worse in the CKD group than in the control group (p = 0.022). In the multivariable analysis, a CKD diagnosis (hazard ratio, 2.261; 95% confidence interval (CI), 1.139-4.486 p = 0.020) was identified as an independent poor prognostic factor for OS. The percentage of patients who died from cardiovascular disease was significantly higher in the CKD group (27.3% vs. 2.3% p = 0.023).
Liver resection for HCC in CKD patients is associated with acceptable perioperative outcomes. However, cardiovascular disease may negatively affect the OS of CKD patients after liver resection.
本研究旨在阐明在患有慢性肾脏病（CKD）的肝细胞癌（HCC）患者中进行肝切除术的可行性。
分析了 2011 年至 2019 年间接受原发性肝癌肝切除术的 204 例患者。比较了 CKD 组和对照组的短期和长期结果。CKD 组的定义为术前估算肾小球滤过率（eGFR）<45 mL/min/1.73 m 和慢性肾脏病 3B 期或更高。
28 例（13.7%）患有 CKD。两组之间的总体并发症发生率无显著差异（46.4%比 34.7%，p=0.229）。CKD 组的胆漏发生率明显高于对照组（14.3%比 4.0%，p=0.048），CKD 组的术后中位住院时间明显长于对照组（11 比 9 天，p=0.031）。两组之间无病生存率无显著差异（p=0.763），但 CKD 组的总生存率（OS）明显低于对照组（p=0.022）。多变量分析显示，CKD 诊断（风险比，2.261；95%置信区间（CI），1.139-4.486，p=0.020）是 OS 的独立预后不良因素。CKD 组死于心血管疾病的患者比例明显高于对照组（27.3%比 2.3%，p=0.023）。
CKD 患者的 HCC 肝切除术与可接受的围手术期结果相关。然而，心血管疾病可能会对 CKD 患者肝切除术后的 OS 产生负面影响。
