Procedure-dependent impact of non-dialysis chronic kidney disease on outcomes after liver resection for hepatocellular carcinoma.

[INTRODUCTION] Renal dysfunction is a known surgical risk factor, yet the influence of procedure type on this risk remains unclear. We examined whether the impact of non-dialysis and dialysis-dependent chronic kidney disease (CKD) on outcomes after liver resection for hepatocellular carcinoma (HCC) differs according to resection type.

[MATERIALS AND METHODS] We retrospectively reviewed 877 HCC patients who underwent liver resection between 2007 and 2024 and categorized them into three groups: normal renal function, non-dialysis CKD (estimated glomerular filtration rate of <45 mL/min/1.73 m), and dialysis-dependent CKD. Short- and long-term outcomes were analyzed using multivariable logistic and Cox regression analyses. Propensity score matching and subgroup analyses stratified by procedure type (anatomical vs. non-anatomical) were performed to validate the findings.

[RESULTS] Compared with normal renal function, non-dialysis CKD was independently associated with increased postoperative complications (overall: odds ratio [OR] 2.14; 95 % confidence interval [CI], 1.19-3.83; p = 0.011; major: OR, 2.60; 95 % CI, 1.28-5.31; p = 0.008), but not with worse survival. Dialysis-dependent CKD was not significantly linked to complications or prognosis. Propensity score matching confirmed a higher complication rate in the non-dialysis CKD group (27 % vs. 14 %, p = 0.047). In subgroup analyses, non-dialysis CKD increased postoperative complications after non-anatomical resection (OR 2.31; p = 0.022), but not after anatomical resection (OR 1.95; p = 0.233), suggesting a procedure-dependent effect.

[CONCLUSION] Non-dialysis CKD independently increases surgical risk without affecting long-term outcomes, with a procedure-dependent risk pattern. Dialysis is not a contraindication to surgery. Tailored operative strategies are essential for HCC patients with CKD.