Gastric cancer surgery for patients with liver cirrhosis

Table 1 Preoperative assessment using the Child-Pugh classification

	Grade A (n = 15)	Grade B (n = 10)	P value
Hemoglobin (g/dL)	13.5 ± 2.0	10.2 ± 2.8	0.006
Platelet (104/μL)	13.0 ± 6.1	9.3 ± 9.6	0.040
Albumin (g/dL)	3.9 ± 0.5	3.0 ± 0.4	0.001
Total bilirubin (mg/dL)	0.8 ± 0.3	0.9 ± 0.5	0.696
Aspartate aminotransferase (IU/L)	40 ± 22	37 ± 15	0.824
Prothrombin time (n = 24, %)	90 ± 19	68 ± 18	0.017
ICG R15 (n = 20, %)	24.3 ± 15.0	30.6 ± 14.2	0.285
K-ICG (n = 20)	0.110 ± 0.033	0.092 ± 0.047	0.165

IU: International units; ICG: Indocyanine green; ICG R15: Indocyanine green retention rate at 15 min; K-ICG: Plasma ICG disappearance rate.

Table 2 Clinicopathological characteristics of 25 GC patients with LC using the Child-Pugh classification

	Grade A (n = 15)	Grade B (n = 10)	P value
Cause of cirrhosis
Alcohol	9	3	0.369
Virus	5	6
HCV-related	5	4
HBV-related	0	1
Both	0	1
Unknown	1	1
Preoperative esophageal varices	5	7	0.111
Intraoperative ascites	0	6	0.001
Extent of gastric resection
Distal	7	5	0.517
Total	7	3
Wedge	1	2
Extent of lymph node dissection
D0	2	3	0.627
D1 (modified gastrectomy A)	8 (6)	4 (4)
D2	4	3
D3	1	0
Residual tumor
R0	15	10	> 0.999
R1/2	0	0
Depth of invasion
pT1	9	7	0.407
pT2	5	2
pT3	1	1
Lymph node metastasis
pN0	11	6	0.758
pN1	1	1
pN2	1	1
pN3	1	0
pNX1	1	2

¹Histological examination of a regional lymphadenectomy specimen includes 14 or less lymph nodes. Depth of invasion, lymph node metastasis, extent of lymph node dissection were recorded in accordance with the Japanese Classification of Gastric Carcinoma. GC: Gastric cancer; LC: Liver cirrhosis; HBV: Hepatitis B virus; HCV: Hepatitis C virus. R0: No residual tumor; R1: Microscopic residual tumor; R2: Macroscopic residual tumor.

Table 3 Intra- and postoperative surgical results using the Child-Pugh classification n (%)

	Grade A (n = 15)	Grade B (n = 10)	P value
Mean operative blood loss (range, mL)	754 (79-2705)	1103 (182-3073)	0.336
Perioperative transfusion of PRBC	5 (33.3)	6 (60.0)	0.241
Mean volume of transfused PRBC (range, mL)	208 (0-1040)	416 (0-1040)	0.198
Perioperative transfusion of FFP	12 (80.0)	6 (60.0)	0.378
Mean volume of transfused FFP (range, mL)	1904 (0-7760)	2968 (0-10 000)	0.575
Morbidity	7 (46.7)	6 (60.0)	0.688
Ascites	1 (6.7)	4 (40.0)	0.041
Intraabdominal infection	0	2 (20.0)	0.071
Hepatic failure	3 (20.0)	0	0.132
Leakage	2 (13.3)	0	0.229
Sepsis	1 (6.7)	0	0.405
Mortality	1 (6.7)1	0	0.405
Median postoperative hospital stay (range, d)	34 (12-63)	29 (12-41)	0.322

¹Mortality was due to hepatic failure. PRBC: Packed red blood cells; FFP: Fresh frozen plasma.

Table 4 Clinicopathological characteristics of GC patients with HCC

Age (yr)	C-P	pT	pN	Surgery for gastric cancer	HCC	Treatment for HCC	Cause of death	Survival time (mo)
71	Grade A	pT1	pNX	Wedge resection, D0	SYN	PEI	HCC	22
62	Grade A	pT1	pN0	Distal GR, D2	MET	PEI, TAE	HCC	80
55	Grade A	pT1	pN0	Distal GR, D1	MET	Unknown	HCC	121
68	Grade B	pT1	pN0	Distal GR, D1	SYN	RFA, PEI, TAE	Alive	64
81	Grade B	pT1	pN0	Distal GR, D1	SYN	None	HCC	46

C-P: Child-Pugh classification; HCC: Hepatocellular carcinoma; SYN: Synchronous; MET: Metachronous; GR: Gastrectomy; PEI: Percutaneous ethanol injection; TAE: Transarterial embolization; RFA: Radiofrequency ablation.