Background/Aims
Recently, mortality following surgical resection for hepatocelluar carcinoma has been
reduced significantly. Morbidity, however, is still significant. This study evaluated the risk factors leading
to morbidity and mortality. Methods: 510 patients who had a hepatic resection form Nov. 1994 to Dec. 2001
were included. The patient demographics showed a mean age of 51.6 years with a male to female ratio of
4:1. The HBsAg was positive in 76.0% and the anti-HCV was positive in 8.2%. The mean tumor size was
5.2 cm, 26.2% of patients had preoperative transcatheter arterial embolization (TAE), and 8.7% had
preoperative percutaneous transhepatic portal embolization (PTPE). Limited resection was performed in 259
cases (50.7%), and major resection was conducted in 251 cases (49.1%). Risk factors included age, sex,
laboratory findings (liver function test, prothrombin time, albumin, glucose, α-fetoprotein, ICG test),
preoperative TAE, PTPE, operation type, operation time, intraoperative transfusion, tumor size, and cirrhosis.
Results
The morbidity was 10.5% (54 cases). Operative death occurred in 5 cases (1.0%). Hospital death,
including operative death, occurred in 6 cases (1.2%). Five cases were associated with hepatic failure and
1 case was associated with aspiration pneumonia accompanying hepatic failure. Transfusion (P=0.002),
glucose (P=0.002), and prothrombin time (P=0.038) were significantly related to morbidity. Age (P=0.028),
glucose (P=0.011), and TAE (P=0.046) were significantly related to mortality. Conclusions: Intraoperative
transfusion, which is mainly related to intraoperative bleeding, should be reduced if possible to decrease
morbidity. Diabetes mellitus patients and the elderly need careful perioperative management.(Korean J
Hepatol 2004;10:51-61)
