HCC: NAFLD etiology tied to more surgical complications but better survival

  • Koh YX & al.
  • J Am Coll Surg
  • 6 Aug 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Hepatocellular carcinoma (HCC) with nonalcoholic fatty liver disease (NAFLD) etiology is associated with greater surgical morbidity and posthepatectomy liver failure, but better 5-year OS.

Why this matters

  • NAFLD-associated HCC is becoming increasingly common, but little is known about long-term outcomes after attempted curative resection.

Study design

  • Retrospective, matched analysis of 996 consecutive patients with HCC undergoing liver resection at a single institution in Singapore; 152 (18.0%) cases were associated with NAFLD.
  • Funding: None disclosed.

Key results

  • Surgical morbidity and postoperative complications were more common with NAFLD vs non-NAFLD HCC:
    • Median intraoperative blood loss (500 vs 400 mL; P=.0252).
    • Intraoperative transfusions (37.8% vs 28%; P=.0208).
    • Minor surgical complications (41.2% vs 24.2%; P<.0001>
    • Major surgical complications (16.2% vs 8.1%; P<.0001>
    • Liver failure (29.5% vs 9.5% for grade A; 20.1% vs 7.2% for grade B/C; P<.0001>
    • Cardiorespiratory complications (11.8% vs 6.8%; P=.0286).
    • Pulmonary embolism (2% vs 0.4%; P=.0176).
    • Total hospital stay (8 vs 6 days; P<.0001>
  • Long-term outcomes were better in the NAFLD group:
    • 5-year OS (70.1% vs 60.9%; P=.0355), although there was a nonequal distribution of propensity score between groups (P=.0411).
    • NAFLD HCC was associated with better OS (aHR, 0.673; P=.0438).

Limitations

  • Retrospective, monocentric design.