Retrospective Study
Copyright ©The Author(s) 2021.
World J Gastrointest Oncol. May 15, 2021; 13(5): 424-439
Published online May 15, 2021. doi: 10.4251/wjgo.v13.i5.424
Table 1 Pre-operative demographics and baseline characteristics of the study population

mean ± SD/ n (%)
Age in years (mean ± SD)59.23 ± 6.52
HCV-related liver disease, n (%)105 (87.5)
Hypertensive, n (%)34 (28.3)
Diabetic, n (%)36 (30)
Previous abdominal operations, n (%)34 (28.3)
Child-Pugh class, n (%)
A590 (75)
A630 (25)
MELD score (mean ± SD)8.54 ± 1.78
MELD score, n (%)
< 1090 (75)
10-2030 (25)
BCLC stage, n (%)
012 (10)
A72 (60)
B36 (30)
Pre-operative upper endoscopy
Oesophageal Varices, n (%)
No78 (65)
Yes42 (35)
Pre-operative imaging
Diameter of largest tumor in cm (mean ± SD)4.57 ± 2.03
Tumor diameter > 5 cm, n (%)
No86 (71.7)
Yes34 (28.3)
Serum Bilirubin (mg/dL)0.87 ± 0.34
Aspartate Aminotransferase (U/L)53.2 ± 29.6
Alanine Aminotransferase (U/L)44.32 ± 25.65
Serum Albumin (g/dL)3.78 ± 0.48
International normalized ratio1.16 ± 0.1
Serum creatinine (mg/dL)0.86 ± 0.22
Platelets count ( 103/mm3)141 ± 64.32
Serum AFP (ng/mL)193.37 ± 343.37
Serum AFP (ng/mL), n (%)
< 2052 (43.3)
20-40030 (25)
> 40020 (16.7)
Undocumented18 (15)
Platelets < 150.000/mm3, n (%)64 (53.3)
Anatomical resection, n (%)22 (18.3)
Use of Harmonic scalpel, n (%)40 (33.3)
Use of Habib sealer, n (%)40 (33.3)
Use of CUSA, n (%)2 (1.7)
Intraoperative bleeding, n (%)4 (3.3)
Blood transfusion, n (%)12 (10)
Plasma transfusion, n (%)6 (5)
Grade of differentiation, n (%)
1 or 258 (48.3)
3 or 438 (31.7)
Undocumented24 (20)
Lymph/vascular invasion, n (%)44 (36.7)
Table 2 Post-operative data and complications after resection in the study population

mean ± SD/ n (%)
Serum bilirubin (mg/dL)1.5 ± 0.64
AST (U/L)29.95 ± 11.31
ALT (U/L)20.51 ± 10.03
Serum albumin (g/dL)3.21 ± 0.41
INR1.25 ± 0.14
Serum Creatinin (mg/dL)0.87 ± 0.23
Serum AFP (ng/mL)2109.7 ± 10795.17
CRP (mg/L)45.99 ± 31.19
Length of the hospital stay (d)8.9 ± 5.05
ICU stay (d)4.28 ± 4.19
Child-Pugh score
On discharge6.62 ± 1.54
3-mo post-operative6.51 ± 1.1
MELD score10.63 ± 2.27
ICU stay, n (%)58 (48.3)
MELD score, n (%)
≤ 1068 (56.7)
> 1052 (43.3)
50-50 criteria, n (%)
Absent116 (96.7)
Present4 (3.3)
PHLF, n (%)
Absent76 (63.3)
Grade A16 (13.3)
Grade B22 (18.3)
Grade C6 (5)
Post-operative complications, n (%)
Hemorrhage4 (3.3)
Bile leak2 (1.7)
Wound infection4 (3.3)
Chest infection14 (11.7)
Recurrence of HCC, n (%)34 (28.3)
Post-operative decompensation, n (%)50 (41.7)
Peri-operative mortality, n (%)4 (3.3)
Overall survival, n (%)
Alive70 (58.3)
Died50 (41.7)
Table 3 Univariate analysis of pre-operative, operative and post-operative factors predictive of hepatic decompensation after liver resection for hepatocellular carcinoma (calculated at 3 mo post-operative)

No decompensation (70 patients)
Decompensation (50 patients)

P value
Age, n (%)
< 60 yr36 (58.1)26 (41.9)0.0040.951
≥ 60 yr34 (58.6)24 (41.0)
Antiviral therapy for HCV, n (%)
No treatment34 (46.6)39 (53.4)29.143< 0.001c
DAAs34 (82.9)7 (17.1)
Interferon2 (33.3)4 (66.7)
Clinically significant portal hypertension, n (%)
No52 (66.7)26 (33.3)7.70.006b
Yes17 (40.5)25 (59.5)
BCLC stage, n (%)
012 (100)0 (0)40.0< 0.001c
A52 (72.2)20 (27.8)
B6 (16.7)30 (83.3)
MELD score, n (%)
< 1060 (68.2)28 (31.8)22.721< 0.001c
10-204 (15.4)22 (84.6)
Pre-operative Child-Pugh score, n (%)
A554 (60)36 (40)0.4110.521
A616 (53.3)14 (46.7)
AFP (ng/mL), n (%)
< 2030 (57.7)22 (42.3)3.5090.173
20-40020 (66.7)10 (33.3)
> 4008 (40)12 (60)
Pre-operative serum bilirubin (mg/dL), n (%)
≤ 146 (57.5)34 (42.5)0.2010.654
> 118 (52.9)16 (47.1)
Tumor diameter > 5 cm, n (%)
No64 (74.4)22 (25.6)32.311< 0.001c
Yes6 (17.6)28 (82.4)
Number of tumors, n (%)
Single68 (60.7)44 (39.3)5.8690.027a
More than one0 (0)4 (100)
Site of tumor(s), n (%)
Right lobe36 (62.1)22 (37.9)1.6260.443
Left lobe32 (57.1)24 (42.9)
Bilobar2 (100)0 (0)
Milan criteria, n (%)
Within36 (69.2)16 (30.8)15.537< 0.001c
Beyond8 (25)24 (75)
Tumor differentiation, n (%)
Grade 1 or 238 (63.3)22 (36.7)1.6460.2
Grade 3 or 418 (50)18 (50)
Lymph/vascular invasion, n (%)
No38 (70.4)16 (29.6)8.5930.003b
Yes18 (40.9)26 (59.1)
Type of resection, n (%)
Open28 (42.4)38 (57.6)13.473< 0.001c
Laparoscopic12 (100)0 (0)
Anatomical resection, n (%)
No38 (57.6)28 (42.4)0.9780.323
Yes10 (45.5)12 (54.5)
Extension of hepatectomy, n (%)
One segment30 (51.7)28 (48.3)2.2410.326
Two segments8 (44.4)10 (55.6)
Three segments2 (100)0 (0)
ICU admission, n (%)
No44 (71)18 (29)8.4250.004b
Yes26 (44.8)32 (55.2)
Postoperative complications, n (%)
Hemorrhage4 (100)0 (0)2.9560.14
Bile leak0 (0)2 (100)2.8470.172
Wound infection0 (0)4 (100)5.7930.028a
Chest infection2 (14.3)12 (85.7)12.652< 0.001c
PHLF, n (%)
Absent54 (71.1)22 (28.9)22.305< 0.001c
Grade A10 (62.5)6 (37.5)
Grade B6 (27.3)16 (72.7)
Grade C0 (0)6 (100)
50-50 criteria, n (%)
Absent70 (60.3)46 (39.7)5.7930.028a
Present0 (0)4 (100)
HCC recurrence, n (%)16 (47.1)18 (52.9)2.4810.115
No decompensationDecompensationt-testP value
mean ± SD
Post-operative bilirubin (mg/dL)1.21 ± 0.491.98 ± 0.57-7.353< 0.001c
Post-operative AFP (ng/mL) 3020.12 ± 13277.79371.63 ± 761.790.9310.355
Post-operative Child-Pugh score5.78 ± 0.657.62 ± 0.58-14.768< 0.001c
Age58.77 ± 6.6859.88 ± 6.29-0.9180.36
Pre-operative Bilirubin (mg/dL)0.87 ± 0.310.87 ± 0.380.0070.994
Pre-operative MELD score8.03 ±1.449.2 ± 1.96-3.5410.001b
Pre-operative Child score5.23 ± 0.425.28 ± 0.45-0.6370.525
Pre-operative AFP (ng/mL)149.58 ± 239.28251.09 ± 441.64-1.3790.173
Tumor diameter (cm)3.77 ± 1.325.68 ± 2.33-5.238< 0.001c
ICU stay (d) 2.92 ± 1.355.38 ± 5.29-2.5220.016a
Hospital stay (d)6.86 ± 2.0811.26 ± 6.34-4.092< 0.001c
Post-operative bilirubin (mg/dL)1.21 ± 0.491.98 ± 0.57-7.353< 0.001c
Post-operative AFP (ng/mL) 3020.12 ± 13277.79371.63 ± 761.790.9310.355
Post-operative Child-Pugh score5.78 ± 0.657.62 ± 0.58-14.768< 0.001c
Table 4 Multivariate analysis of factors predictive of hepatic decompensation after resection

OR
95%CI
P value
Age1.090.96-1.250.184
Preoperative MELD score2.651.23-5.720.013a
Preoperative serum bilirubin0.150.01-3.630.242
Clinically significant portal hypertension
NoReferenceReference0.191
Yes4.390.48-40.25
Tumor diameter (cm)5.421.99-14.770.001b
Hospital stay (d)2.491.46-4.220.001b
ICU admission
NoReferenceReference0.448
Yes0.420.05-3.92
Table 5 Univariate survival analysis of the predictors of survival in study population
Mean survival time (mo)95%CILog-rank testP value
Clinically significant portal hypertension
No40.635.3-460.5510.458
Yes39.530.9-48.1
Preoperative AFP > 400 ng/mL
No43.938.3-49.58.7870.003b
Yes24.614.1-35.2
Preoperative MELD score
< 1046.3841.13-51.6319.209< 0.001c
10-2022.5513.44-31.65
BCLC stage
051.940.5-63.222.328< 0.001c
A47.942.1-53.6
B26.118.3-33.8
PHLF
No47.141.4-52.88.4890.004b
Yes32.124.8-39.4
PHLF grade
Absent47.141.4-52.8114.117< 0.001c
A42.230.4-53.9
B31.723-40.4
C2.10.5-3.6
50-50 criteria
Absent43.638.8-48.3156.853< 0.001c
Present0.80.7-0.8
Post-operative MELD score
≤ 1049.343.4-55.312.29< 0.001c
> 1032.725.8-39.7
Post-operative decompensation
No52.247.1-57.427.716< 0.001c
Yes28.321.1-35.5
HCC recurrence
No53.348.7-57.969.639< 0.001c
Yes13.29.6-16.8
Table 6 Multivariate analysis of independent prognostic factors for the survival of patients after the liver resection surgery for hepatocellular carcinoma

HR
95%CI
P value
Age (yr)1.020.96-1.080.493
Preoperative MELD score1.371.16-1.62< 0.001c
Preoperative AFP (ng/mL)1.0011-1.0020.08
BCLC stage
0ReferenceReference0.757
A0.590.12-2.91
B0.450.06-3.65
PHLF grade
AbsentReferenceReference< 0.001c
A2.330.59-9.24
B3.151.11-8.95
C373.4166.23-2105.43
Postoperative MELD score > 101.030.39-2.670.958
Postoperative decompensation2.030.64-6.460.23
HCC recurrence11.674.19-32.52< 0.001c