Predictors of 90-Day Mortality following Hepatic Resection for Hepatocellular Carcinoma

Abstract

<b><i>Background/Purpose:</i></b> 90-day mortality is a key performance indicator for short-term perioperative outcome of hepatic resection (HR). Although many preoperative, intraoperative, and postoperative variables predict 90-day mortality following elective HR, only few are specific to hepatocellular carcinoma (HCC). This study aims to determine the predictors of 90-day mortality following elective HR for HCC. <b><i>Methods:</i></b> We report a retrospective analysis of patients who underwent elective HR between January 1, 2007, and December 31, 2017. Health status, perioperative variables, and the presence of post-hepatectomy liver failure (PHLF) were studied. Cox’s regression evaluated factors predicting 90-day mortality. <b><i>Results:</i></b> Two hundred and forty-four patients diagnosed with HCC underwent HR; 102 (41.8%) underwent a major HR. The postoperative 90-day mortality rate was 5.3%. Multivariate analysis demonstrated that Child-Pugh score (<i>p</i> &#x3c; 0.001), intraoperative blood loss (<i>p</i> = 0.013), the 50-50 criteria for PHLF (<i>p</i> &#x3c; 0.001) on postoperative day 5, and peak serum bilirubin &#x3e;119 µmol/L (<i>p</i> = 0.007) on postoperative day 3 predict 90-day mortality. <b><i>Conclusion:</i></b> In patients with HCC undergoing HR, Child-Pugh score, intraoperative blood loss, the 50-50 criteria for PHLF on postoperative day 5, and peak serum bilirubin &#x3e;119 µmol/L on postoperative day 3 predict 90-day mortality following elective HR for HCC.