Ann Surg Treat Res.  2024 Feb;106(2):68-77. 10.4174/astr.2024.106.2.68.

Safety of nighttime elective hepatectomy for hepatocellular carcinoma patients: a retrospective study

• Qiu Zc
• Wu Yw
• Qi Wl
• Li C

• KMID: 2552387
• DOI: http://doi.org/10.4174/astr.2024.106.2.68

Abstract

Purpose
This study aimed to investigate whether nighttime elective surgery influenced the short-term outcomes and prognosis of hepatocellular carcinoma (HCC) patients.
Methods
The 1,339 HCC patients who underwent hepatectomy were divided into the daytime surgery group (8 a.m.–6 p.m., n = 1,105) and the nighttime surgery group (after 6 p.m., n = 234) based on the start time of surgery. The 1:2 propensity score matching (PSM) analysis was used to control confounding factors. The short-term outcomes of HCC patients in the 2 groups were compared before and after PSM. Factors associated with major complications (Clavien-Dindo grade, ≥III) and textbook oncologic outcomes (TOO) were separately identified by multivariable logistic regression based on variables screened via least absolute shrinkage and selection operator (LASSO). The Kaplan-Meier method was used to analyze overall survival (OS) and recurrence-free survival (RFS).
Results
TOO was achieved after surgery in 897 HCC patients. HCC patients in the nighttime surgery group had a higher body mass index (P = 0.010). After 1:2 PSM, the baseline characteristics of patients between the 2 groups were similar. Short-term outcomes in HCC patients were comparable both before and after PSM (all Ps > 0.05), as were TOO in the 2 groups before (P = 0.673) and after PSM (P = 0.333). In our LASSO-logistic regression, nighttime surgery was not an independent factor associated with major complications or TOO. Both groups also had similar OS (P = 0.950) and RFS (P = 0.740) after PSM.
Conclusion
Our study revealed the safety of nighttime elective hepatectomy for HCC patients.

Keyword

Hepatocellular carcinoma; Hepatectomy; Safety

Figure

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  Fig. 1 Flow chart for inclusion of hepatocellular carcinoma (HCC) patients who underwent hepatectomy.

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  Fig. 2 Textbook oncologic outcomes (TOO) distribution stratified by the specific parameters among patients undergoing hepatectomy for hepatocellular carcinoma. LOS, length of stay.

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  Fig. 3 Screening of variables based on the least absolute shrinkage and selection operator (LASSO) regression. (A) The variation characteristics of the coefficient of variables of major complication. (B) Identification of the optimal penalization coefficient λ in the LASSO model of major complications. (C) The variation characteristics of the coefficient of variables of textbook oncologic outcomes (TOO). (D) Identification of the optimal penalization coefficient λ in the LASSO model of TOO. Variables included operation start time (daytime surgery/nighttime surgery), sex, age, smoke, alcohol, hypertension, diabetes mellitus, intraoperative bleeding, intraoperative blood transfusion, anatomical hepatectomy, major hepatectomy, operation time, laparoscope, Barcelona Clinic Liver Cancer stage, Milan criteria, single tumor, tumor size, HBV-related hepatocellular carcinoma, HBV-DNA, erythrocyte, hemoglobin, albumin-bilirubin grade, international normalized ratio, body mass index, α-FP, total bilirubin, albumin, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio.

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  Fig. 4 The Kaplan-Meier curve of patients with hepatocellular carcinoma who underwent hepatectomy in the matched 2 groups. (A) Overall survival after propensity score matching (PSM). (B) Recurrence-free survival after PSM

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