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Value of Live Donor Liver Transplantation Experience in Major Hepatectomy for Hepatocellular Carcinoma
See-Ching Chan, FRACDS, FRCS(Edin);
Chi-Leung Liu, MS, FRCS(Edin);
Chung-Mau Lo, MS, FRACS, FRCS(Edin);
Chi-Ming Lam, MS, FRCS(Edin);
Ronnie Tung-Ping Poon, MS, FRCS(Edin);
Wai-Key Yuen, FRCS(Glasg), FRACS;
Sheung-Tat Fan, MS, MD, PhD, FRCS(Glasg), FRCS(Edin);
John Wong, PhD, FRACS, FRCS(Edin)
Arch Surg. 2003;138:265-271.
Background Live donor liver transplantation (LDLT) mandates conversance in liver anatomy and major hepatectomy. Hepatocellular carcinoma is most reliably treated by hepatectomy.
Hypothesis The outcomes of major hepatectomy for hepatocellular carcinoma are influenced by the surgeon's LDLT experience.
Design We collected prospective cohort study data on patient and disease characteristics.
Setting Tertiary referral center.
Patients A retrospective study was performed on 250 patients who underwent major hepatectomy for hepatocellular carcinoma from January 16, 1996, through December 28, 2001.
Main Outcome Measures Overall and disease-free survival and outcomes including blood loss, blood transfusion, and complications.
Results The 3 liver transplantation surgeons (LTSs) performed 102 major hepatectomies; the 4 hepatobiliary and pancreatic surgeons (HBPSs), 148 major hepatectomies. Patients in both groups had similar baseline characteristics. The mean ± SD blood loss in the LTS and HBPS groups was 1.36 ± 1.37 and 2.21 ± 2.40 L, respectively (P<.001). The mean ± SD blood transfusion in the LTS and HBPS groups was 0.27 ± 0.82 and 0.51 ± 0.94 L, respectively (P = .001). Fewer patients in the LTS group required blood transfusion (17/102 [16.7%]; HBPS group, 57/148 [38.5%]; P<.001). We found no difference in overall and disease-free survival between the groups. The median overall survival was 55.8 months for the nontransfused group, and 34.3 months for the transfused group (P = .06). Median disease-free survival was 16.1 months for the nontransfused group compared with 12.4 months for the transfused group (P = .25). Cox regression multivariate analysis showed that transfusion, cirrhosis, and venous invasion worsened overall survival. Venous invasion, cirrhosis, and tumor size adversely affected disease-free survival.
Conclusions The LTS group lost less blood and required less blood transfusions than the HBPS group. Blood transfusion worsened overall survival. The significantly lower blood transfusion requirement of the LTS group contributes to a potential advantage in their overall survival.
From the Center for the Study of Liver Disease and the Department of Surgery, The University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong.
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