POSTOPERATIVE COMPLICATIONS OF LIVER RESECTION FOR HEPATOCELLULAR CARCINOMA

Abstract

Background:

Postoperative complications continue to be a major challenge following liver resection for hepatocellular carcinoma despite advances in surgical techniques and perioperative care. These complications adversely affect patient recovery, increase morbidity, prolong hospital stay, and may compromise long-term outcomes. Bile leakage is one of the most common and clinically important complications after liver resection, with reported incidence ranging from 3.3% to 8.7%. Understanding the frequency and risk factors of postoperative complications is essential to improve perioperative management and patient outcomes.

Objective(s):

To evaluate the postoperative complications of liver resection for hepatocellular carcinoma.

Methodology:

A descriptive cross-sectional study was conducted among 47 patients who underwent liver resection for hepatocellular carcinoma at Shaikh Zayed Hospital Lahore. Data were collected from a prospectively maintained database documenting demographic characteristics, clinical variables, comorbidities, tumor characteristics, operative parameters, and postoperative complications. All patients underwent open liver resection performed by experienced hepatobiliary surgeons. Data were entered and analyzed using SPSS version 27. Descriptive statistics were applied to calculate frequencies and percentages.

Results:

Among the 47 patients, the majority were in the 41-50 years age group (19, 40.4%), with a slight female predominance (27, 57.4%). Most patients had normal BMI (21, 44.7%). Regarding comorbidities, hypertension was present in 18 patients (38.3%), diabetes in 12 patients (25.5%), and coronary disease in 11 patients (23.4%). Smoking history was reported in 17 patients (36.2%) and alcohol consumption in 9 patients (19.1%). Tumor characteristics revealed that the majority of tumors were located in the right hepatic lobe (37, 78.7%), with tumor diameter less than 5 cm in 26 patients (55.3%). Preoperative plasma albumin levels were above 5 g/L in 36 patients (76.6%), and ASA score 1-2 was observed in 32 patients (68.1%). Hemi hepatectomy was the most frequently performed procedure (31, 66.0%), with operation time less than 5 hours in 29 patients (61.7%) and blood loss less than 500 mL in 28 patients (59.6%). Postoperatively, biliary fistula was observed in 6 patients (12.8%), and drainage time exceeded 72 hours in 35 patients (74.5%).

Conclusion(s):

The findings of this study indicate that liver resection for hepatocellular carcinoma is associated with a number of postoperative complications, with biliary fistula being the most frequently observed complication. The majority of patients had preserved liver function, which may have contributed to the absence of more severe complications such as post-hepatectomy liver failure. These findings highlight the need for careful patient selection, meticulous surgical technique, and close postoperative monitoring to improve outcomes.