Prabowo Erik, Susilaningsih Neni, Suharti Catharina, Purnomo Hery D, Riwanto Ignatius, Fuadi Ahmad F, Ar Ardiyana, Bulandari Beatrice LA, Tjandra Kevin C, Respati Danendra Rk, Rampengan Derren Dch
Doctoral Study Program of Medical and Health Science, Universitas Diponegoro, Semarang, Indonesia.
Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia.
Narra J. 2024 Dec;4(3):e1001. doi: 10.52225/narra.v4i3.1001. Epub 2024 Oct 11.
Hepatocellular carcinoma (HCC) ranks among the most prevalent and fatal liver cancers globally. Liver surgery, particularly resection, offers the potential for cure but poses challenges, especially in Indonesia, where patients often present in advanced stages. This study aimed to determine the intraoperative and perioperative factors associated with 30- day mortality of HCC patients undergoing liver resection at a tertiary referral hospital. The study included HCC patients undergoing liver resection at Karadi General Hospital, Semarang, Indonesia, between January 2018 and September 2023. Demographic data, intraoperative, perioperative, and postoperative factors were collected, with the primary outcome being 30-day mortality. Factors influencing 30-day survival were assessed using a log-rank test and the survival analysis employed Kaplan-Meier curves. Among 58 HCC patients who had liver resection, 62.1% were males, with a mean age was 57.27 ± 9.56 years. Preoperative comorbidities, notably hepatitis B, affected 34.4% of patients. Child-Pugh Score categorized 91.4% as class A. The study found a 30-day mortality rate of 10.3% with no subsequent increase in incidence. The failure-to-rescue rate (FTR) of this study was found 46%. Factors associated with 30-day mortality were Child-Pugh classification ( < 0.001), intraoperative bleeding ( = 0.001), creatinine levels ( = 0.005), Clavien-Dindo classification ( < 0.001), and posthepatectomy liver failure (PHLF) ( < 0.001). This study suggests that preoperative (Child-Pugh classification), intraoperative (blood loss volume), and postoperative factors (Creatinine level, Clavien-Dindo classification, and PHLF) could predict the mortality rate of HCC patients undergoing liver resection.
肝细胞癌（HCC）是全球最常见且致命的肝癌之一。肝脏手术，尤其是切除术，提供了治愈的可能性，但也带来了挑战，在印度尼西亚尤其如此，那里的患者往往在疾病晚期才前来就诊。本研究旨在确定在一家三级转诊医院接受肝切除的HCC患者30天死亡率的术中及围手术期相关因素。该研究纳入了2018年1月至2023年9月期间在印度尼西亚三宝垄卡拉迪综合医院接受肝切除的HCC患者。收集了人口统计学数据、术中、围手术期及术后因素，主要结局为30天死亡率。使用对数秩检验评估影响30天生存的因素，并采用Kaplan-Meier曲线进行生存分析。在58例接受肝切除的HCC患者中，62.1%为男性，平均年龄为57.27±9.56岁。术前合并症，尤其是乙型肝炎，影响了34.4%的患者。Child-Pugh评分将91.4%的患者归类为A类。研究发现30天死亡率为10.3%，且发病率无后续增加。本研究的未抢救成功率（FTR）为46%。与30天死亡率相关的因素有Child-Pugh分级（<0.001）、术中出血（=0.001）、肌酐水平（=0.005）、Clavien-Dindo分级（<0.001）和肝切除术后肝功能衰竭（PHLF）（<0.001）。本研究表明，术前（Child-Pugh分级）、术中（失血量）及术后因素（肌酐水平、Clavien-Dindo分级和PHLF）可预测接受肝切除的HCC患者的死亡率。
