Outcomes in Patients with Chronic Kidney Disease After Liver Resection for Hepatocellular Carcinoma

• DOI: 10.1007/s00268-020-05829-z
• Publication Date: 2020-10-21T17:03:51Z
• Authors: Takahiro Yoshikawa; Takeo Nomi; Daisuke Hokuto; Naoki Kamitani; Yasuko Matsuo; Masayuki Sho
• Keywords: Aged, 80 and over; Male; Carcinoma, Hepatocellular; Liver Neoplasms; Middle Aged; Survival Analysis; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Cardiovascular Diseases; Risk Factors; Feasibility Studies; Hepatectomy; Humans; Female; Renal Insufficiency, Chronic; Aged; Glomerular Filtration Rate; Retrospective Studies

AbstractBackgroundThe aim of this study was to clarify the feasibility of liver resection in hepatocellular carcinoma (HCC) patients with chronic kidney disease (CKD).MethodsIn 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.ResultsTwenty‐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).ConclusionsLiver 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.