Clinical outcome of cardiac surgery in patients with remitted or active hepatocellular carcinoma

Abstract

Purpose

Hepatocellular carcinoma (HCC) is one of the most common primary cancers worldwide. HCC has unique characteristics such as co-existing chronic liver damage and a high recurrence rate. A negative impact on the surgical outcome due to these backgrounds could be expected. We aimed to evaluate the clinical outcomes of cardiac surgery in these patients.

Methods

Between January 2000 and December 2019, 16 patients with remitted cancer and 5 patients with active HCC who underwent open heart surgery were studied. The clinical data were retrospectively evaluated from hospital records. Follow-up information was collected via telephone interviews.

Results

The major cause of HCC was viral hepatitis. Eighteen patients (86%) were classified as having Child–Pugh class A cirrhosis. The mean model of end-stage liver disease (MELD) score was 7.2 ± 5.2. There was no 30-day mortality. During follow-up, 11 patients died due to HCC. The 1-, 3-, and 5-year survival rates were 80.0, 42.5, and 22.3%, respectively. A univariate analysis identified a higher preoperative MELD score and lower serum cholinesterase levels as prognostic factors for long-term survival.

Conclusion

We could safely perform cardiac surgery in selected patients with remitted and active HCC. The postoperative life expectancy of these patients was limited but acceptable.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Lorusso R, Vizzardi E, Johnson DM, Mariscalco G, Sciatti E, Maessen J, et al. Cardiac surgery in adult patients with remitted or active malignancies: a review of preoperative screening, surgical management and short- and long-term postoperative results. Eur J Cardiothorac Surg. 2018;54:10–8.

    Article  Google Scholar 

  2. 2.

    Carrascal Y, Gualis J, Arévalo A, Fulquet E, Flórez S, Rey J, et al. Cardiac surgery with extracorporeal circulation in cancer patients: influence on surgical morbidity and mortality, and on survival. Rev Esp Cardiol. 2008;61:369–75.

    Article  Google Scholar 

  3. 3.

    Nardi P, Pellegrino A, Pugliese M, Bovio E, Chiariello L, Ruvolo G. Cardiac surgery with extracorporeal circulation and concomitant malignancy: early and long-term results. J Cardiovasc Med. 2016;17:152–9.

    Article  Google Scholar 

  4. 4.

    Chan J, Rosenfeldt F, Chaudhuri K, Marasco S. Cardiac surgery in patients with a history of malignancy: influence complication rate but similar mortality. Heart Lung Circ. 2012;21:255–9.

    Article  Google Scholar 

  5. 5.

    Canver CC, Marrin CAS, Plume SK, Nugent WC. Should a patient with a treated cancer be offered an open heart operation? Ann Thorac Surg. 1993;55:1202–4.

    CAS  Article  Google Scholar 

  6. 6.

    Mistiaen WP, Van Cauwelaert P, Muylaert P, Wuyts F, Harrisson F, Bortier H. Effect of prior malignancy on survival after cardiac surgery. Ann Thorac Surg. 2004;77:1593–7.

    Article  Google Scholar 

  7. 7.

    Schoenmakers MCJ, van Boven WJ, vanden Bosch J, van Swieten HA. Comparison of on-pump or off-pump coronary artery revascularization with lung resection. Ann Thorac Surg. 2007;84:504–9.

    Article  Google Scholar 

  8. 8.

    Fornar A, Reig M, Bruix J. Hapatocellular carcinoma. Lancet. 2018;391:1303–14.

    Google Scholar 

  9. 9.

    Kudo M, Izumi N, Sakamoto M, Matsuyama Y, Ichida T, Nakashima O, et al. Survival analysis over 28 years of 173,378 patients with hepatocellular carcinoma in Japan. Liver Cancer. 2016;5:190–7.

    Article  Google Scholar 

  10. 10.

    Hasegawa K, Kokudo N, Makuuchi M, Izumi N, Ichida T, Kudo M, et al. Comparison of resection and ablation for hepatocellular carcinoma: a cohort study based on a Japanese nationwide survey. J Hepatol. 2013;58:724–9.

    Article  Google Scholar 

  11. 11

    Hasegawa K, Makuuchi M, Takayama T, Kokudo N, Arii S, Okazaki M, et al. Surgical resection vs. percutaneous ablation for hepatocellular carcinoma: a preliminary report of the Japanese nationwide survey. J Hepatol. 2008;49:589–94.

    Article  Google Scholar 

  12. 12.

    Shimizu H, Katano Y, Nagano K, Yokozaki S, Shimizu F, Naito T, et al. Recurrent hepatocellular carcinoma with rapid growth after cardiac surgery. Hepatogastrienterology. 2005;52:1863–6.

    Google Scholar 

  13. 13.

    Hayashida N, Shoujima T, Teshima H, Yokokura Y, Takagi T, Tomoeda H, et al. Clinical outcome after cardiac operation in patients with cirrhosis. Ann Thorac Surg. 2004;77:500–5.

    Article  Google Scholar 

  14. 14.

    Wallwork K, Ali JM, Abu-Omar Y, De Silva R. Does liver cirrhosis lead to inferior outcomes following cardiac surgery? Interact CardioVasc Thorac Surg. 2019;28:102–7.

    Article  Google Scholar 

  15. 15.

    Chou AH, Chen TH, Chen CY, Chen SW, Lee CW, Liao CH, et al. Long-term outcome of cardiac surgery in 1,040 liver cirrhosis patient—nationwide population-based cohort study. Circ J. 2017;81:476–84.

    Article  Google Scholar 

  16. 16.

    Sablotzki A, Dehne M, Welters I, Lehmann N, Görlach G, Osmer C, et al. Alterations of cytokine network in patients undergoing cardiopulmonary bypass. Perfusion. 1997;12:393–403.

    CAS  Article  Google Scholar 

  17. 17.

    Tajima K, Yamamoto F, Kawazoe K, Nakatani I, Sakai H, Abe T, et al. Cardiopulmonary bypass and cellular immunity: changes in lymphocyte subsets and natural killer cell activity. Ann Thorac Surg. 1993;55:625–30.

    CAS  Article  Google Scholar 

  18. 18.

    Markewitz A, Lante W, Franke A, Marohl K, Kuhlmann WD, Weinhold C. Alterations of cell-mediated immunity following cardiac operation: clinical implications and open questions. Shock. 2001;16:10–5.

    Article  Google Scholar 

  19. 19.

    Yamamoto S, Yoshimatsu T, Nishimura Y, Uchida S, Toguchi K, Honda K, et al. In vitro evaluation of the effect of cardiac surgery on cancer cell proliferation. Ann Thorac Cardiovasc Surg. 2011;17:260–6.

    Article  Google Scholar 

  20. 20.

    Suzuki S, Usui A, Yoshida K, Matsumura A, Ichihara T, Ueda Y. Effect of cardiopulmonary bypass on cancer prognosis. Asian Cardiovasc Thorac Ann. 2010;18:536–40.

    Article  Google Scholar 

  21. 21.

    Platell C. Influence of cardiopulmonary bypass surgery on cancer-specific survival rate of patients with colorectal cancer. Dis Colon Rectum. 1998;41:1371–5.

    CAS  Article  Google Scholar 

  22. 22.

    Vieira RD, Pereira AC, Lima EG, Garzillo CL, Rezende PC, Favarato D, et al. Cancer-related deaths among different treatment options in chronic coronary artery disease: results of a 6-year follow-up of the MASS II study. Coron Artery Dis. 2012;23:79–84.

    Article  Google Scholar 

  23. 23.

    Biancari F, Dahlbacka S, Juvonen T, Virtanen MPO, Maaranen P, Jaakkola J, et al. Favorable outcome of cancer patients undergoing transcatheter aortic valve replacement. Int J Cardiol. 2020 (online ahead of print).

  24. 24.

    Watanabe Y, Kozuma K, Hioki H, Kawashima H, Nara Y, Kataoka A, et al. Comparison of results of transcatheter aortic valve implantation in patients with versus without active cancer. Am J Cardiol. 2016;118:572–7.

    Article  Google Scholar 

  25. 25.

    Yassin AS, Subahi A, Abubakar H, Akintoye E, Alhusain R, Adegbala O, et al. Outcomes and effects of hepatic cirrhosis in patients who underwent transcatheter aortic valve implantation. Am J Cardiol. 2018;122:455–60.

    Article  Google Scholar 

  26. 26.

    Alqahtani F, Aljohani S, Ghabra A, Alahdab F, Kawsara A, Holmes DR, et al. Outcomes of transcatheter versus surgical aortic valve implantation for aortic stenosis in patients with hepatic cirrhosis. Am J Cardiol. 2017;120:1193–7.

    Article  Google Scholar 

  27. 27.

    Quintana RA, Monlezun DJ, Davogustto G, Saenz HR, Lozano-Ruiz F, Sueta D, et al. Outcomes following percutaneous coronary intervention in patients with cancer. Int J Cardiol. 2020;300:106–12.

    Article  Google Scholar 

  28. 28.

    Krone RJ. Managing coronary artery disease in the cancer patient. Prog Cardiovasc Dis. 2010;53:149–56.

    Article  Google Scholar 

  29. 29.

    Ochi M, Yamada K, Fujii M, Ohkubo N, Ogasawara H, Tanaka S. Role of off-pump coronary artery bypass grafting in patients with malignant neoplastic disease. Jpn Circ J. 2000;64:13–7.

    CAS  Article  Google Scholar 

Download references

Funding

This study was not supported by any funding.

Author information

Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by KT, KA, TT, HO, TS, YS, TK, YZ, SK, KS, and AO. This study was supervised by ET. The first draft of the manuscript was written by KT, and all authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Kazuyoshi Takagi.

Ethics declarations

Conflict of interest

All authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Takagi, K., Arinaga, K., Takaseya, T. et al. Clinical outcome of cardiac surgery in patients with remitted or active hepatocellular carcinoma. Surg Today (2021). https://doi.org/10.1007/s00595-021-02239-z

Download citation

Keywords

  • Hepatocellular carcinoma
  • Liver cirrhosis
  • Cardiac surgery
  • Outcome