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Impact of comorbid renal dysfunction in patients with hepatocellular carcinoma on long-term outcomes after curative resection

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Title: Impact of comorbid renal dysfunction in patients with hepatocellular carcinoma on long-term outcomes after curative resection
Authors: Sakamoto, Yuzuru Browse this author →KAKEN DB
Shimada, Shingo Browse this author
Kamiyama, Toshiya Browse this author
Sugiyama, Ko Browse this author
Asahi, Yoh Browse this author
Nagatsu, Akihisa Browse this author
Orimo, Tatsuya Browse this author
Kakisaka, Tatsuhiko Browse this author
Kamachi, Hirofumi Browse this author
Ito, Yoichi M. Browse this author
Taketomi, Akinobu Browse this author →KAKEN DB
Keywords: Hepatocellular carcinoma
Renal dysfunction
Estimated glomerular filtration rate
Issue Date: 27-Jul-2022
Publisher: Baishideng Publishing Group
Journal Title: World journal of gastrointestinal surgery
Volume: 14
Issue: 7
Start Page: 670
End Page: 684
Publisher DOI: 10.4240/wjgs.v14.i7.670
Abstract: BACKGROUND Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. However, the number of patients with chronic kidney disease (CKD) is on the rise because of the increase in lifestyle-related diseases. AIM To establish a tailored management strategy for HCC patients, we evaluated the impact of comorbid renal dysfunction (RD), as stratified by using the estimated glomerular filtration rate (EGFR), and assessed the oncologic validity of hepatectomy for HCC patients with RD. METHODS We enrolled 800 HCC patients who underwent hepatectomy between 1997 and 2015 at our university hospital. We categorized patients into two (RD, EGFR < 60 mL/min/1.73 m(2); non-RD, EGFR >= 60 mL/min/1.73 m(2)) and three groups (severe CKD, EGFR < 30 mL/min/1.73 m(2); mild CKD, 30 <= EGFR < 60 mL/min/1.73 m(2); control, EGFR >= 60 mL/min/1.73 m(2)) according to renal function as defined by the EGFR. Overall survival (OS) and recurrence-free survival (RFS) were compared among these groups with the log-rank test, and we also analyzed survival by using a propensity score matching (PSM) model to exclude the influence of patient characteristics. The mean postoperative observation period was 64.7 +/- 53.0 mo. RESULTS The RD patients were significantly older and had lower serum total bilirubin, aspartate aminotransferase, and aspartate aminotransferase levels than the non-RD patients (P < 0.0001, P < 0.001, P < 0.05, and P < 0.01, respectively). No patient received maintenance hemodialysis after surgery. Although the overall postoperative complication rates were similar between the RD and non-RD patients, the proportions of postoperative bleeding and surgical site infection were significantly higher in the RD patients (5.5% vs 1.8%; P < 0.05, 3.9% vs 1.8%; P < 0.05, respectively), and postoperative bleeding was the highest in the severe CKD group (P < 0.05). Regardless of the degree of comorbid RD, OS and RFS were comparable, even after PSM between the RD and non-RD groups to exclude the influence of patient characteristics, liver function, and other causes of death. CONCLUSION Comorbid mild RD had a negligible impact on the prognosis of HCC patients who underwent curative hepatectomy with appropriate perioperative management, and close attention to severe CKD is necessary to prevent postoperative bleeding and surgical site infection.
Type: article
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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