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Hokkaido University Collection of Scholarly and Academic Papers >
Graduate School of Medicine / Faculty of Medicine >
Peer-reviewed Journal Articles, etc >
Impact of comorbid renal dysfunction in patients with hepatocellular carcinoma on long-term outcomes after curative resection
| 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 | | Hepatectomy | | 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 |
| URI: | http://hdl.handle.net/2115/86939 |
| 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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