Clinical factors affecting liver failure in patients with HBV related hepatocellular carcinoma after hepatectomy

Abstract

Abstract: Objective To analyze the possible risk factors for acute liver failure (ALF) after hepatectomy in patients with hepatitis B virus (HBV) cirrhosis and hepatocellular carcinoma (HCC), and to prevent the occurrence of ALF after liver resection. Methods 61 patients with HCC after HBV cirrhosis in our hospital from June 2019 to June 2021 were selected. The occurrence of postoperative ALF was observed, the general clinical data of patients were recorded, and the possible risk factors were analyzed. Results Among 61 patients with HCC related to HBV cirrhosis, 10 cases with posthepatectomy liver failure (PHLF group), and 51 cases without PHLF (non-PHLF group). The age of PHLF group and non-PHLF group was (58.3 ± 4.9) years and (45.8 ± 5.6) years, and the difference was statistically significant(P<0.05). Child-Pugh grade A, B and C in PHLF group were 3 cases (30.0%), 7 cases (70.0%) and 0(0), while those in non-PHLF group were 36 cases (70.6%), 15 cases (29.4%) and 0(0), the difference was statistically significant(P<0.05). The tumor diameter, intraoperative blood loss and operation time in PHLF group were (9.3 ± 1.9)cm, (1235.89 ± 158.0)mL and (267.15 ± 59.5)min, which were significantly different from those in non-PHLF group [(6.2 ± 1.5)cm and (879.5 ± 105.3)mL and (223.12 ± 39.12)min],the difference was statistically significant(P<0.05). Irregular resection and lobectomy of liver in PHLF group were 3 cases (30.0%) and 7 cases (70.0%), while those in non-PHLF group were 41 cases (80.4%) and 10 cases (19.6%), the difference was statistically significant (P<0.05). Transcatheter arterial chemoembolization (TACE) was found in 1 case (10.0%) and 27 cases (52.9%) in PHLF group and non-PHLF group, and no TACE was found in 9 cases (90.0%) and 24 cases (47.1%) in PHLF group and non-PHLF group, the difference was statistically significant(P<0.05). Whether ALF occurred or not was taken as the dependent variable, and the independent variables were the statistically significant factors in the above univariate analysis. Logistic regression analysis was used. The results showed that age, Child-Pugh grade, tumor diameter, surgical resection range, intraoperative blood loss, intraoperative blood transfusion, preoperative TACE were related to the occurrence of PHLF (P<0.05). Conclusion ALF after hepatectomy in patients with HBV related HCC may be related to age, Child-Pugh grade, tumor diameter, surgical resection range, intraoperative blood loss and intraoperative blood transfusion. Preoperative TACE is a protective factor.

Key words: Hepatocellular carcinoma, Liver resection, Acute liver failure, Hepatitis B cirrhosis

ZHAO Zi-yu, WANG Ming-qiang, NIU Yao-fei. Clinical factors affecting liver failure in patients with HBV related hepatocellular carcinoma after hepatectomy[J]. Chinese Hepatolgy, 2022, 27(10): 1092-1095.

References

[1] 中华医学会肝病学分会. 原发性肝癌二级预防共识(2021年版). 中华肝脏病杂志, 2021,29(3):216-226.
[2] 胡泽明, 陈彪, 钟佳宁, 等. 原发性肝癌治疗方法的应用进展. 山东医药, 2019,59(9):106-110.
[3] S?reide JA, Deshpande R. Post hepatectomy liver failure (PHLF)-Recent advances in prevention and clinical management. Eur J Surg Oncol, 2021,47(2):216-224.
[4] 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版). 临床肝胆病杂志, 2019,35(1):38-44.
[5] 陈锐俊, 薛梅, 高燕灵, 等. 乙型肝炎相关肝硬化肝癌和无肝硬化肝癌患者围术期情况及肝衰竭危险因素分析. 河北医科大学学报, 2018,39(6):640-644.
[6] Yokoyama Y, Schwacha MG, Samy TS, et al. Gender dimorphism in immune responses following trauma and hemorrhage. Immunol Res, 2002,26(1-3):63-76.
[7] Rahnemai-Azar AA, Cloyd JM, Weber SM, et al. Update on Liver Failure Following Hepatic Resection: Strategies for Prediction and Avoidance of Post-operative Liver Insufficiency. J Clin Transl Hepatol, 2018,6(1):97-104.
[8] 王才彬, 苏洋. 肝切除术后肝衰竭发生的危险因素及防治方法. 临床肝胆病杂志, 2020,36(9):2119-2124.
[9] Peng Y, Wei Q, Liu Y, et al. Prediction and Risk Factors for Prognosis of Cirrhotic Patients with Hepatic Encephalopathy. Gastroenterol Res Pract, 2021,2021:5623601.
[10] 张长坤, 张龙辉, 王东, 等. 术前肝功能Child-Pugh评分与白蛋白-胆红素评分对肝癌患者肝切除术后肝衰竭和预后的预测价值. 中华消化外科杂志, 2018,17(5):474-482.
[11] 唐丽, 肖昌倩. 影响肝癌肝切除术患者术后肝衰竭的多因素分析. 肝胆外科杂志, 2019,27(6):462-465.
[12] 尹天圣.肝癌肝切除术后肝衰竭危险因素的Meta分析.重庆医科大学,2015:1-29.
[13] 白石磊, 项红军, 夏勇, 等. 乙型肝炎病毒相关孤立性大肝癌手术切除的远期疗效及预后因素分析. 中华消化外科杂志, 2017,16(2):151-158.
[14] Kita S, Yasuchika K, Ishii T, et al. The Protective Effect of Transplanting Liver Cells Into the Mesentery on the Rescue of Acute Liver Failure After Massive Hepatectomy. Cell Transplant, 2016,25(8):1547-1559.
[15] Imai D, Maeda T, Wang H, et al. Risk Factors for and Outcomes of Intraoperative Blood Loss in Liver Resection for Hepatocellular Tumors. Am Surg, 2021,87(3):376-383.