BACKGROUND: Postoperative complications may adversely affect oncological outcomes. The aim of this study was to evaluate the impact of postoperative complications on early-phase recurrence after curative resection for hepatocellular carcinoma (HCC).

METHODS: We included 145 HCC patients who underwent initial and curative resection between January 2004 and December 2013. Postoperative complications of grade III or higher based on Clavien-Dindo classification were defined as clinically relevant postoperative complications. Recurrence within two years after hepatectomy was defined as early-phase recurrence.

RESULTS: Thirty-eight patients (26%) developed postoperative complications. The only predictive factor for postoperative complication was longer operative duration (P?=?0.037). The disease-specific survival rate of patients with complication was lower than that of patients without complications (P?=?0.015). Early-phase recurrence was observed in 20/38 (53%) patients who suffered postoperative complications and 36/107 (34%) patients with no complications, which was statistically significant (P?=?0.039). Multivariate analysis identified four factors contributing to early-phase recurrence: high serum AFP level (P?=?0.042), multiple tumors (P?<?0.001), poor differentiation (P?=?0.036) and presence of postoperative complication (P?=?0.039).

CONCLUSIONS: Postoperative complication is an independent prognostic factor for early-phase recurrence after curative resection of HCC. Close observation of patients with postoperative complications may be a necessary treatment strategy for HCC.