Abstract: Objective
To investigate the effects of esophageal varices (EV) on the incidence of complications and prognosis of patients with hepatocellular carcinoma (HCC) and hepatic cirrhosis after radical resection.
Methods
The clinical data of 455 patients with HCC and hepatic cirrhosis who were admitted to the Affiliated Hospital of Qingdao University from January 2001 to December 2010 were retrospectively analyzed. All the patients were divided into the EV group (61 patients) and non EV group (394 patients) according to the results of preoperative imaging examination. The intraoperative condition and the prognosis of the patients in the 2 groups were compared. All the patients were re examined every month within the first 3 months after operation, and then they were re examined every 3 months thereafter. The follow up was ended till December, 2012 or the day of patients′ death. Comparison of the measurement data and rates was done by chi square test; the survival curve was drawn by Kaplan Meier method, and the survival was analyzed using the Log rank test; multivariate analysis was done by Cox proportional hazard regression model.
Results
All the patients received radical hepatectomy. Four patients received hepatectomy+pericardial devascularization, 18 received hepatectomy+splenectomy (3 of them received pericardial devascularization). The ratios of patients with the distance between the resection margin and the tumor< 0.5 cm, splenectomy, volume of intraoperative blood loss≥1000 ml and intraoperative blood transfusion in the EV group were significantly greater than those in the non EV group ( χ 2-136.3 months). There were 218 patients died, including 37 patients in the EV group and 181 in the non EV group. The ratios of patients died of HCC, hepatic diseases or other reasons were 67.57%(25/37), 29.73%(11/37) and 2.70%(1/37) in the EV group, and 86.19% (156/181), 6.63%(12/181) and 7.18%(13/181) in the non EV group, with significant difference between the 2 groups ( χ 2 =12.517, 5.370, 12.711, 4.430, 7.148, 29.616, 47.111, P <0.05). The results of multivariate analysis showed that tumor diameter>5 cm and non solitary tumor were independent risk factors influencing the prognosis of patients with HCC and hepatic cirrhosis after radical resection ( RR=1.639, 2.041, P <0.05) .
Conclusion
The survival time of cirrhotic HCC patients with EV is significantly shorter than those without EV after radical resection, while EV was not the independent risk factor influencing the survival of cirrhotic HCC patients after radical resection.