Mixed Outcomes After Liver Resection for NAFLD-Associated Cancer

By Will Boggs MD

August 28, 2019

NEW YORK (Reuters Health) - Liver resection for nonalcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC) is associated with favorable long-term survival but with more surgical morbidity and post-hepatectomy liver failure, compared with non-NAFLD HCC, researchers from Singapore report.

"Curative resection should be pursued for NAFLD HCC where possible," lead author Dr. Ye Xin Koh from Singapore General Hospital told Reuters Health by email. "However, vigilant perioperative care is needed to mitigate the complications that might occur."

NAFLD-related HCC appears to have worse survival outcomes than HCC of other etiologies, but it remains unclear whether curative surgery improves long-term outcomes for NAFLD-related HCC.

Dr. Koh's team investigated perioperative and long-term outcomes after liver resection in their study of 152 patients with NAFLD HCC and 844 patients with non-NAFLD HCC.

A smaller proportion of the NAFLD group underwent major resections, but there were significantly more minor (41.2% vs. 24.2%) and major complications (16.2% vs. 8.1%) in this group than in the non-NAFLD group, the researchers report in the Journal of the American College of Surgeons, online August 6.

Significantly more patients in the NAFLD group than in the non-NAFLD group developed grade A liver failure (29.5% vs. 9.5%) or grade B/C liver failure (20.1% vs. 7.2%) after liver resection.

Despite these differences, five-year overall survival was significantly better in the NAFLD group (70.1%) than in the non-NAFLD group (60.9%). After adjustment for various factors, the risk of mortality was 32.7% lower in the NAFLD group.

Factors contributing to poorer survival included age, congestive cardiac failure, Child B status, cirrhosis, tumor size, multinodularity, and R1 (incomplete) resection.

"Although the perioperative complications associated with liver resection were higher in the NAFLD group, the long-term survival justifies the risk of surgery," Dr. Koh said.

"It is important to formulate a clinical management plan for accurate identification of NAFLD before surgery," he said. "This will help to prognosticate outcomes, stratify operative risks, and aid counseling for the patients."

Dr. Vlad Ratziu of Sorbonne Universite and Institute for Cardiometabolism and Nutrition, in Paris, who recently reviewed trends and outcomes of NAFLD HCC in patients undergoing liver resection, told Reuters Health by email, "The study clearly shows the burden of NAFLD-related HCC in Southeast Asia (16% of this series), a region where the overwhelming majority of liver diseases were traditionally due to viral hepatitis. This, therefore, confirms the trend of a strong rise in incidence of NAFLD in this part of the world in the last decade, similar to what has been happening in the West."

"The surprising finding of this series is the high proportion of postoperative complications, including liver failure," he said. "Some of the postoperative complications, in particular cardiovascular, are to be expected given that NAFLD patients are older and have more comorbidities. However, the larger proportion of liver failure postoperatively is surprising given the fact that these patients had a better preserved liver function and less often cirrhosis preoperatively. This needs definitely to be confirmed by other studies."

"Despite this high incidence of postoperative complications, long-term prognosis was similar, which pleads for an aggressive surgical management strategy in NAFLD patients with this tumor," Dr. Ratziu said.

SOURCE: https://bit.ly/2Mv2hDY

J Am Coll Surg 2019.