Published online Jul 27, 2022. doi: 10.4240/wjgs.v14.i7.670
Peer-review started: January 30, 2022
First decision: March 12, 2022
Revised: March 28, 2022
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: July 27, 2022
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.
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.
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 m2; non-RD, EGFR ≥ 60 mL/min/1.73 m2) and three groups (severe CKD, EGFR < 30 mL/min/1.73 m2; mild CKD, 30 ≤ EGFR < 60 mL/min/1.73 m2; control, EGFR ≥ 60 mL/min/1.73 m2) 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.
The RD patients were significantly older and had lower serum total bilirubin, aspartate amino
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.
Core Tip: This retrospective study revealed that comorbid renal dysfunction (RD) had a negligible impact on the prognosis of hepatocellular carcinoma patients who underwent curative hepatectomy with appropriate perioperative management, and close attention to severe chronic kidney disease is necessary to prevent postoperative bleeding and surgical site infection. Of particular interest is the finding that regardless of the degree of comorbid RD, the overall survival rate and recurrence-free survival rate were comparable, even when using a propensity model to exclude the influence of patient characteristics, liver function, and other causes of death. Moreover, no RD patient, even severe RD patients, received maintenance hemodialysis after hepatectomy.