nach oben

Erschienen in:

14.12.2022 | Hepatobiliary Tumors

Association of Viral Hepatitis Status and Post-hepatectomy Outcomes in the Era of Direct-Acting Antivirals

verfasst von: Luckshi Rajendran, MD, MEd, Woo Jin Choi, MD, Hala Muaddi, MD, PhD, Tommy Ivanics, MD, MPH, Jordan J. Feld, MD, MPH, Marco P. A. W. Claasen, MD, Matthew Castelo, MD, Gonzalo Sapisochin, MD, PhD, MSc

Erschienen in: Annals of Surgical Oncology | Ausgabe 5/2023

Einloggen, um Zugang zu erhalten

Abstract

Background

The role of viral hepatitis status in post-hepatectomy outcomes has yet to be delineated. This large, multicentred contemporary study aimed to evaluate the effect of viral hepatitis status on 30-day post-hepatectomy complications in patients treated for hepatocellular carcinoma (HCC).

Methods

Patients from the National Surgical Quality Improvement Program (NSQIP) database with known viral hepatitis status, who underwent hepatectomy for HCC between 2014 and 2018, were included. Patients were classified as HBV-only, HCV-only, HBV and HCV co-infection (HBV/HCV), or no viral hepatitis (NV). Multivariable models were used to assess outcomes of interest. The primary outcome was any 30-day post-hepatectomy complication. The secondary outcomes were major complications and post-hepatectomy liver failure (PHLF). Subgroup analyses were performed for cirrhotic and noncirrhotic patients.

Results

A total of 3234 patients were included. The 30-day complication rate was 207/663 (31.2%) HBV, 356/1077 (33.1%) HCV, 29/81 (35.8%) HBV/HCV, and 534/1413 (37.8%) NV (p = 0.01). On adjusted analysis, viral hepatitis status was not associated with occurrence of any 30-day post-hepatectomy complications (ref: NV, HBV odds ratio (OR) 0.89 [95% confidence interval (CI): 0.71–1.12]; HCV OR 0.91 [95% CI: 0.75–1.10]; HBV/HCV OR 1.17 [95% CI: 0.71–1.93]). Similar results were found in cirrhotic and noncirrhotic subgroups, and for secondary outcomes: occurrence of any major complications and PHLF.

Conclusions

In patients with HCC managed with resection, viral hepatitis status is not associated with 30-day post-hepatectomy complications, major complications, or PHLF compared with NV. This suggests that clinical decisions and prognostication of 30-day outcomes in this population likely should not be made based on viral hepatitis status.

Liu Z, Xu K, Jiang Y, et al. Global trend of aetiology-based primary liver cancer incidence from 1990 to 2030: a modelling study. Int J Epidemiol. 2021;50(1):128–42. https://doi.org/10.1093/ije/dyaa196.CrossRefPubMed

de Mattos AZ, Debes JD, Boonstra A, et al. Current impact of viral hepatitis on liver cancer development: The challenge remains. World J Gastroenterol. 2021;27(24):3556–67. https://doi.org/10.3748/wjg.v27.i24.3556.CrossRefPubMedPubMedCentral

Lee CW, Tsai HI, Sung CM, et al. Risk factors for early mortality after hepatectomy for hepatocellular carcinoma. Med (Baltim). 2016;95(39):e5028. https://doi.org/10.1097/MD.0000000000005028.CrossRef

Zhong JH, Ke Y, Gong WF, et al. Hepatic resection associated with good survival for selected patients with intermediate and advanced-stage hepatocellular carcinoma. Ann Surg. 2014;260(2):329–40. https://doi.org/10.1097/SLA.0000000000000236.CrossRefPubMed

Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg. 2000;191(1):38–46. https://doi.org/10.1016/s1072-7515(00)00261-1.CrossRefPubMed

Spolverato G, Ejaz A, Kim Y, et al. Patterns of care among patients undergoing hepatic resection: a query of the National Surgical Quality Improvement Program-targeted hepatectomy database. J Surg Res. 2015;196(2):221–8. https://doi.org/10.1016/j.jss.2015.02.016.CrossRefPubMed

Utsunomiya T, Shimada M, Kudo M, et al. A comparison of the surgical outcomes among patients with HBV-positive, HCV-positive, and non-B non-C hepatocellular carcinoma: a nationwide study of 11,950 patients. Ann Surg. 2015;261(3):513–20. https://doi.org/10.1097/SLA.0000000000000821.CrossRefPubMed

Wu CC, Ho WL, Chen JT, Tang JS, Yeh DC, P’Eng FK. Hepatitis viral status in patients undergoing liver resection for hepatocellular carcinoma. Br J Surg. 1999;86(11):1391–6. https://doi.org/10.1046/j.1365-2168.1999.01272.x.CrossRefPubMed

Jia HD, Liang L, Li C, et al. Long-term surgical outcomes of liver resection for hepatocellular carcinoma in patients with HBV and HCV co-infection: a multicenter observational study. Front Oncol. 2021;11:700228. https://doi.org/10.3389/fonc.2021.700228.CrossRefPubMedPubMedCentral

10.

Lee JJ, Kim PT, Fischer S, et al. Impact of viral hepatitis on outcomes after liver resection for hepatocellular carcinoma: results from a North American center. Ann Surg Oncol. 2014;21(8):2708–16. https://doi.org/10.1245/s10434-014-3609-6.CrossRefPubMed

11.

Kao WY, Su CW, Chau GY, Lui WY, Wu CW, Wu JC. A comparison of prognosis between patients with hepatitis B and C virus-related hepatocellular carcinoma undergoing resection surgery. World J Surg. 2011;35(4):858–67. https://doi.org/10.1007/s00268-010-0928-z.CrossRefPubMed

12.

Kabir T, Syn NL, Tan ZZX, et al. Predictors of post-operative complications after surgical resection of hepatocellular carcinoma and their prognostic effects on outcome and survival: a propensity-score matched and structural equation modelling study. Eur J Surg Oncol. 2020;46(9):1756–65. https://doi.org/10.1016/j.ejso.2020.03.219.CrossRefPubMed

13.

Lai Y, Lee JC, Hung HC, et al. Models to predict disease-free survival for hepatocellular carcinoma patients with surgical resections. J Surg Oncol. 2020;122(7):1444–52. https://doi.org/10.1002/jso.26169.CrossRefPubMed

14.

Li Z, Zhao X, Jiang P, et al. HBV is a risk factor for poor patient prognosis after curative resection of hepatocellular carcinoma: a retrospective case-control study. Med (Baltim). 2016;95(31):e4224. https://doi.org/10.1097/MD.0000000000004224.CrossRef

15.

Panel AIHG. Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus. Hepatology. 2015;62(3):932–54. https://doi.org/10.1002/hep.27950.CrossRef

16.

Lockart I, Hajarizadeh B, Buckley N, et al. All-cause hepatocellular carcinoma survival in the era of direct-acting antiviral therapy. J Gastroenterol Hepatol. 2021;36(12):3515–23. https://doi.org/10.1111/jgh.15687.CrossRefPubMed

17.

Tabrizian P, Saberi B, Holzner ML, et al. Outcomes of transplantation for HBV- versus HCV-related HCC: impact of DAA HCV therapy in a national analysis of >20,000 patients. HPB (Oxford). 2021. https://doi.org/10.1016/j.hpb.2021.11.018.CrossRefPubMed

18.

von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–9. https://doi.org/10.1016/j.ijsu.2014.07.013.CrossRef

19.

Ingraham AM, Richards KE, Hall BL, Ko CY. Quality improvement in surgery: the American college of surgeons national surgical quality improvement program approach. Adv Surg. 2010;44:251–67. https://doi.org/10.1016/j.yasu.2010.05.003.CrossRefPubMed

20.

Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96. https://doi.org/10.1097/SLA.0b013e3181b13ca2.CrossRefPubMed

21.

Sood A, Meyer CP, Abdollah F, et al. Minimally invasive surgery and its impact on 30-day postoperative complications, unplanned readmissions and mortality. Br J Surg. 2017;104(10):1372–81. https://doi.org/10.1002/bjs.10561.CrossRefPubMed

22.

Gurien LA, Ra JH, Crandall M, Kerwin AJ, Tepas JJ 3rd. Clavien-Dindo analysis of NSQIP data objectively measures patient-focused quality. Am Surg. 2019;85(8):789–93.CrossRefPubMed

23.

Pathak P, Tsilimigras DI, Hyer JM, Diaz A, Pawlik TM. Timing and severity of postoperative complications and associated 30-day mortality following hepatic resection: a national surgical quality improvement project study. J Gastrointest Surg. 2022;26(2):314–22. https://doi.org/10.1007/s11605-021-05088-w.CrossRefPubMed

24.

Surgeons ACo. User guide for the 2018 ACS NSQIP participant use data file (PUF). PDF. October 2019, 2019. https://www.facs.org/-/media/files/quality-programs/nsqipnsqip_puf_userguide_2018.ashx

25.

Ye JZ, Mai RY, Guo WX, et al. Nomogram for prediction of the international study Group of Liver Surgery (ISGLS) grade B/C Posthepatectomy liver failure in HBV-related hepatocellular carcinoma patients: an external validation and prospective application study. BMC Cancer. 2020;20(1):1036. https://doi.org/10.1186/s12885-020-07480-2.CrossRefPubMedPubMedCentral

26.

Hoffmann K, Hinz U, Stravodimos C, et al. Risk assessment for liver resection. Surgery. 2018;164(5):998–1005. https://doi.org/10.1016/j.surg.2018.06.024.CrossRefPubMed

27.

Dhir M, Samson KK, Yepuri N, Yanala UR, Smith LM, Are C. Preoperative nomogram to predict posthepatectomy liver failure. J Surg Oncol. 2021;123(8):1750–6. https://doi.org/10.1002/jso.26463.CrossRefPubMed

28.

Etra JW, Squires MH 3rd, Fisher SB, et al. Early identification of patients at increased risk for hepatic insufficiency, complications and mortality after major hepatectomy. HPB (Oxford). 2014;16(10):875–83. https://doi.org/10.1111/hpb.12270.CrossRefPubMedPubMedCentral

29.

FE Harrell Jr MHJ, D Hmisc. Package ‘rms.’ 2017; 299

30.

Harrell F. Missing data. In: Regression modeling strategies. Springer; 2015. P. 45-61.

31.

Rubin D. Multiple imputation after 18+ years. J Am Stat Assoc. 1996;91(434):473–89.CrossRef

32.

Team RC. A language and environment for statistical computing. 2021. https//www R-project org/[Google Sch

33.

Perisetti A, Goyal H, Yendala R, Thandassery RB, Giorgakis E. Non-cirrhotic hepatocellular carcinoma in chronic viral hepatitis: Current insights and advancements. World J Gastroenterol. 2021;27(24):3466–82. https://doi.org/10.3748/wjg.v27.i24.3466.CrossRefPubMedPubMedCentral

34.

Singal AG, Rich NE, Mehta N, et al. Direct-acting antiviral therapy for hepatitis C virus infection is associated with increased survival in patients with a history of hepatocellular carcinoma. Gastroenterology. 2019;157(5):1253-1263 e2. https://doi.org/10.1053/j.gastro.2019.07.040.CrossRefPubMed

35.

Hsu PY, Hsu CT, Yeh ML, et al. Early fibrosis but late tumor stage and worse outcomes in hepatocellular carcinoma patients without hepatitis B or hepatitis C. Dig Dis Sci. 2020;65(7):2120–9. https://doi.org/10.1007/s10620-019-05938-3.CrossRefPubMed

36.

Li Q, Li H, Qin Y, Wang PP, Hao X. Comparison of surgical outcomes for small hepatocellular carcinoma in patients with hepatitis B versus hepatitis C: a Chinese experience. J Gastroenterol Hepatol. 2007;22(11):1936–41. https://doi.org/10.1111/j.1440-1746.2006.04619.x.CrossRefPubMed

37.

Wakiyama S, Matsumoto M, Haruki K, et al. Clinical features and outcome of surgical patients with non-B non-C hepatocellular carcinoma. Anticancer Res. 2017;37(6):3207–13. https://doi.org/10.21873/anticanres.11682.CrossRefPubMed

38.

Zhang EL, Li J, Li J, Wang WQ, Gu J, Huang ZY. Sub-classification of cirrhosis affects surgical outcomes for early hepatocellular carcinoma independent of portal hypertension. Front Oncol. 2021;11:671313. https://doi.org/10.3389/fonc.2021.671313.CrossRefPubMedPubMedCentral

39.

Shehta A, Farouk A, Fouad A, et al. Post-hepatectomy liver failure after hepatic resection for hepatocellular carcinoma: a single center experience. Langenbecks Arch Surg. 2021;406(1):87–98. https://doi.org/10.1007/s00423-020-01956-2.CrossRefPubMed

40.

Kim JM, Rhu J, Ha SY, Choi GS, Kwon CHD, Joh JW. Hepatectomy outcomes in patients with hepatitis C virus-related hepatocellular carcinoma with or without cirrhosis. Ann Surg Treat Res. 2022;102(1):1–9. https://doi.org/10.4174/astr.2022.102.1.1.CrossRefPubMedPubMedCentral

41.

Elshaarawy O, Aman A, Zakaria HM, et al. Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis. World J Gastrointest Oncol. 2021;13(5):424–39. https://doi.org/10.4251/wjgo.v13.i5.424.CrossRefPubMedPubMedCentral

42.

Sultana A, Brooke-Smith M, Ullah S, et al. Prospective evaluation of the International Study Group for Liver Surgery definition of post hepatectomy liver failure after liver resection: an international multicentre study. HPB (Oxford). 2018;20(5):462–9. https://doi.org/10.1016/j.hpb.2017.11.007.CrossRefPubMed

43.

Aragon RJ, Solomon NL. Techniques of hepatic resection. J Gastrointest Oncol. 2012;3(1):28–40. https://doi.org/10.3978/j.issn.2078-6891.2012.006.CrossRefPubMedPubMedCentral

Titel: Association of Viral Hepatitis Status and Post-hepatectomy Outcomes in the Era of Direct-Acting Antivirals
verfasst von: Luckshi Rajendran, MD, MEd
Woo Jin Choi, MD
Hala Muaddi, MD, PhD
Tommy Ivanics, MD, MPH
Jordan J. Feld, MD, MPH
Marco P. A. W. Claasen, MD
Matthew Castelo, MD
Gonzalo Sapisochin, MD, PhD, MSc
Publikationsdatum: 14.12.2022
Verlag: Springer International Publishing
Erschienen in: Annals of Surgical Oncology / Ausgabe 5/2023
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-022-12937-8

Neu im Fachgebiet Chirurgie

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

Was nützt die Kraniektomie bei schwerer tiefer Hirnblutung?

17.05.2024 Hirnblutung Nachrichten

Eine Studie zum Nutzen der druckentlastenden Kraniektomie nach schwerer tiefer supratentorieller Hirnblutung deutet einen Nutzen der Operation an. Für überlebende Patienten ist das dennoch nur eine bedingt gute Nachricht.

Klinikreform soll zehntausende Menschenleben retten

15.05.2024 Klinik aktuell Nachrichten

Gesundheitsminister Lauterbach hat die vom Bundeskabinett beschlossene Klinikreform verteidigt. Kritik an den Plänen kommt vom Marburger Bund. Und in den Ländern wird über den Gang zum Vermittlungsausschuss spekuliert.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Association of Viral Hepatitis Status and Post-hepatectomy Outcomes in the Era of Direct-Acting Antivirals