Ye Xin Koh1, Hiang Jin Tan2, Yi Xin Liew3, Nicholas Syn2, Jin Yao Teo4, Ser Yee Lee4, Brian K P Goh4, George B B Goh5, Chung Yip Chan4. 1. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore. Electronic address: koh.ye.xin@singhealth.com.sg. 2. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore. 3. Department of Pharmacy, Singapore General Hospital, Singapore. 4. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Duke-National University of Singapore Medical School, Singapore. 5. Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Duke-National University of Singapore Medical School, Singapore.
Abstract
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD)-related hepatocellular carcinoma (HCC) is on the rise worldwide, but data on long-term outcomes after curative operations are limited. The primary aim of this study was to characterize the perioperative and long-term outcomes after liver resection. The secondary aim was to investigate the influence of the histologic severity of nonalcoholic steatohepatitis and its impact on perioperative outcomes and long-term survival. METHODS: A total of 996 patients who underwent liver resection for HCC in our institution were analyzed. Patients were categorized into subgroups of NAFLD vs non-NAFLD HCC based on histologic evidence of hepatic steatosis. Comparisons of patients' demographic, clinical, and surgical characteristics; postoperative complications; and survival outcomes were performed. RESULTS: Eight hundred and forty-four patients had non-NAFLD HCC and 152 patients had NAFLD HCC. Comorbidities were significantly more common in the NAFLD group (p < 0.0001). In the non-NAFLD group, larger median tumor size, higher liver cirrhosis, and lower median neutrophil to lymphocyte ratio were observed (p < 0.0001). The NAFLD group had a greater amount of intraoperative blood loss, more postoperative complications, and longer length of stay. Five-year overall survival was significantly better in the NAFLD group (p = 0.0355). Significant factors that contribute to poorer survival outcomes include age, congestive cardiac failure, Child-Pugh's class B, cirrhosis, tumor size, multinodularity, and R1 resection. For NAFLD group, patients with abnormal parenchyma showed poorer survival and 5-year overall survival rates (64.8% vs 75.6%; p = 0.2291). CONCLUSIONS: Nonalcoholic fatty liver disease-related HCC is associated with greater surgical morbidity and post-hepatectomy liver failure. Despite this, long-term survival outcomes are favorable compared with non-NAFLD etiologies.
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD)-related hepatocellular carcinoma (HCC) is on the rise worldwide, but data on long-term outcomes after curative operations are limited. The primary aim of this study was to characterize the perioperative and long-term outcomes after liver resection. The secondary aim was to investigate the influence of the histologic severity of nonalcoholic steatohepatitis and its impact on perioperative outcomes and long-term survival. METHODS: A total of 996 patients who underwent liver resection for HCC in our institution were analyzed. Patients were categorized into subgroups of NAFLD vs non-NAFLD HCC based on histologic evidence of hepatic steatosis. Comparisons of patients' demographic, clinical, and surgical characteristics; postoperative complications; and survival outcomes were performed. RESULTS: Eight hundred and forty-four patients had non-NAFLD HCC and 152 patients had NAFLD HCC. Comorbidities were significantly more common in the NAFLD group (p < 0.0001). In the non-NAFLD group, larger median tumor size, higher liver cirrhosis, and lower median neutrophil to lymphocyte ratio were observed (p < 0.0001). The NAFLD group had a greater amount of intraoperative blood loss, more postoperative complications, and longer length of stay. Five-year overall survival was significantly better in the NAFLD group (p = 0.0355). Significant factors that contribute to poorer survival outcomes include age, congestive cardiac failure, Child-Pugh's class B, cirrhosis, tumor size, multinodularity, and R1 resection. For NAFLD group, patients with abnormal parenchyma showed poorer survival and 5-year overall survival rates (64.8% vs 75.6%; p = 0.2291). CONCLUSIONS: Nonalcoholic fatty liver disease-related HCC is associated with greater surgical morbidity and post-hepatectomy liver failure. Despite this, long-term survival outcomes are favorable compared with non-NAFLD etiologies.
Authors: Ian J Y Wee; Fiona N N Moe; Rehena Sultana; Reiko W T Ang; Pearly P S Quek; Brian Kim Poh Goh; Chung Yip Chan; Peng Chung Cheow; Alexander Y F Chung; Prema Raj Jeyaraj; Ye Xin Koh; Peter O P Mack; London Lucien P J Ooi; Ek Khoon Tan; Jin Yao Teo; Juinn Huar Kam; Jacelyn S S Chua; Ashley W Y Ng; Jade S Q Goh; Pierce K H Chow Journal: J Hepatocell Carcinoma Date: 2022-08-17
Authors: Anastasia Murtha-Lemekhova; Juri Fuchs; Svenja Feiler; Erik Schulz; Miriam Teroerde; Eva Kalkum; Rosa Klotz; Adrian Billeter; Pascal Probst; Katrin Hoffmann Journal: BMC Med Date: 2022-01-28 Impact factor: 8.775