Sakamoto Y, Shimada S, Kamiyama T, Sugiyama K, Asahi Y, Nagatsu A, Orimo T, Kakisaka T, Kamachi H, Ito YM, Taketomi A. Impact of comorbid renal dysfunction in patients with hepatocellular carcinoma on long-term outcomes after curative resection. World J Gastrointest Surg 2022; 14(7): 670-684 [PMID: 36158275 DOI: 10.4240/wjgs.v14.i7.670]
Corresponding Author of This Article
Shingo Shimada, MD, PhD, Surgeon, Department of Gastroenterological Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Hokkaido, Japan. shingoshimada1979@true.ocn.ne.jp
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yuzuru Sakamoto, Shingo Shimada, Toshiya Kamiyama, Ko Sugiyama, Yoh Asahi, Akihisa Nagatsu, Tatsuya Orimo, Tatsuhiko Kakisaka, Hirofumi Kamachi, Akinobu Taketomi, Department of Gastroenterological Surgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan
Yoichi M Ito, Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan
Author contributions: Sakamoto Y, Shimada S, Kamiyama T contributed to the conception and design; Kamiyama T, Kamachi H, Taketomi A involved in the provision of study materials or patients; Sakamoto Y, Shimada S, Sugiyama K, Asahi Y, Nagatsu A, Orimo T, Kakisaka T contributed to the collection and assembly of data; Sakamoto Y, Shimada S, Kamiyama T, Ito YM involved in the data analysis and interpretation; all authors contributed to the manuscript writing; and all authors approved final manuscript.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki (as revised in 2013) and approved by the Institutional Review Board of Hokkaido University Hospital (No. 016-0354).
Informed consent statement: Voluntary written consent was obtained from all patients.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: We cannot share the data collected for our study with others because of the confidentiality rules of our hospital.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shingo Shimada, MD, PhD, Surgeon, Department of Gastroenterological Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Hokkaido, Japan. shingoshimada1979@true.ocn.ne.jp
Received: January 30, 2022 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 Processing time: 178 Days and 5.2 Hours
Abstract
BACKGROUND
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.
AIM
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.
METHODS
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.
RESULTS
The RD patients were significantly older and had lower serum total bilirubin, aspartate aminotransferase, and aspartate aminotransferase levels than the non-RD patients (P < 0.0001, P < 0.001, P < 0.05, and P < 0.01, respectively). No patient received maintenance hemodialysis after surgery. Although the overall postoperative complication rates were similar between the RD and non-RD patients, the proportions of postoperative bleeding and surgical site infection were significantly higher in the RD patients (5.5% vs 1.8%; P < 0.05, 3.9% vs 1.8%; P < 0.05, respectively), and postoperative bleeding was the highest in the severe CKD group (P < 0.05). Regardless of the degree of comorbid RD, OS and RFS were comparable, even after PSM between the RD and non-RD groups to exclude the influence of patient characteristics, liver function, and other causes of death.
CONCLUSION
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.
