Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma

Background: Extended hepatectomy with resection of more than four segments is a high-risk operation, especially in patients with hepatocellular carcinoma (HCC) associated with chronic liver disease. This study evaluated the risk factors for morbidity and mortality following extended hepatectomy for HCC. Methods: Preoperative and intraoperative variables of 155 patients who underwent extended hepatectomy for HCC were analysed to identify risk factors for postoperative morbidity and mortality. Results: The overall morbidity rate was 55.5 per cent (n=86). Most morbidity was due to ascites or pleural effusion. Significant life-threatening complications occurred in 20.0 per cent (n=31). The perioperative mortality rate was 8.4 per cent (n=13). Multivariate analysis found that portal clamping (P=0.023) and perioperative blood transfusion (P<0.001) were risk factors for morbidity, whereas perioperative blood transfusion (P<0.001) was the only risk factor for significant morbidity. Co-morbid illness (P=0.019) and perioperative blood transfusion (P=0.004) were risk factors for perioperative mortality. Conclusion: Meticulous operative techniques to minimize blood loss and transfusion, while avoiding a prolonged Pringle manoeuvre, may help reduce postoperative morbidity. Avoidance of perioperative blood transfusion and careful preoperative selection of patients in terms of overall physiological status are important measures to reduce the postoperative mortality rate.