Outcomes in Patients with Chronic Kidney Disease After Liver Resection for Hepatocellular Carcinoma
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ORIGINAL SCIENTIFIC REPORT
Outcomes in Patients with Chronic Kidney Disease After Liver Resection for Hepatocellular Carcinoma Takahiro Yoshikawa1 • Takeo Nomi1 • Daisuke Hokuto1 • Naoki Kamitani1 • Yasuko Matsuo1 Masayuki Sho1
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Accepted: 11 October 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background The aim of this study was to clarify the feasibility of liver resection in hepatocellular carcinoma (HCC) patients with chronic kidney disease (CKD). Methods 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 m2 and chronic kidney disease Stage 3B or higher. Results 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). Conclusions 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.
Introduction Chronic kidney disease (CKD), as defined by the kidney disease outcome quality initiative (K / DOQI), has been increasingly recognized as a public health priority and is a Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00268-020-05829-z) contains supplementary material, which is available to authorized users. & Takeo Nomi [email protected] 1
Department of Surgery, Nara Medical University, 840 Shijocho Kashihara-shi, Nara 634-8522, Japan
current target of prevention programs [1–3]. In one study, by regularly measuring the estimated glomerular filtration rate (eGFR), it was estimated that nearly half of the elderly patients had CKD [4–7]. Patients with CKD have high morbidity and mortality, high access to health care, and poor quality of life [8–10]. CKD is a well-known risk factor for increased morbidity and mortality in patients undergoing vascular and cardiac surgery. Recently, several studies have reported that CKD is a risk factor for postoperative complications, such as massive ascites, pleural effusion, and circulat
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