LAUSR

BACKGROUND Non-alcoholic fatty liver disease (NAFLD)-related hepatocellular carcinoma (HCC) is on the rise worldwide but data regarding long-term outcomes after curative surgery were limited. The primary aim of this study was to characterize the perioperative and long-term outcomes after liver resection. The secondary aim was to investigate the influence of the histological severity of non-alcoholic steatohepatitis (NASH) and its impact on perioperative outcomes and long-term survival. METHODS A total of 996 patients who underwent liver resection for HCC in our institution were analyzed. Patients were categorized into subgroups of NAFLD vs non NAFLD HCC based on histological evidence of hepatic steatosis. Comparisons of patients' demographic, clinical, surgical characteristics, post op complications and survival outcomes were performed. RESULTS 844 patients had non-NAFLD HCC while 152 patients had NAFLD HCC. Co-morbidities were significantly more common in the NAFLD group. (p<0.0001) In non-NAFLD group, larger median tumor size, higher liver cirrhosis, lower median NLR were observed (p<0.0001). NAFLD group had greater amount of intra-operative blood loss, post-operative complications and length of stay. 5-year overall survival were significantly better in NAFLD group. (p=0.0355) Significant factors that contribute to a poorer survival outcome include age, congestive cardiac failure, Child B status, cirrhosis, tumor size, multi-nodularity and R1 resection. For NAFLD group, patients with abnormal parenchyma showed poorer survival and 5-year OS. 64.8% vs 75.6%, (p=0.2291). CONCLUSIONS NAFLD associated HCC is associated with greater surgical morbidity and post hepatectomy liver failure. Despite this, the long-term survival outcomes are favorable compared to non-NAFLD etiologies.