Purposes: Whether hepatectomy is justified in patients with hepatocellular carcinoma (HCC) on hemodialysis (HD) for end-stage renal disease (ESRD) is unclear. This study evaluated clinical characteristics and outcomes in patients with HCC on HD for ESRD who underwent hepatectomy.

Methods: Hepatectomy was performed in 17 patients in an ESRD group and 181 in a non-ESRD group. We compared clinical characteristics and outcomes between these groups.

Results: Compared with the non-ESRD group, the ESRD group had a significantly higher rate of diabetes mellitus, higher serum creatinine levels, lower levels of hemoglobin, aspartate aminotransferase, and alanine aminotransferase, and a lower indocyanine green retention rate at 15 min. There were no significant differences between the 2 groups in other clinical characteristics, laboratory data, surgical outcomes, pathological findings, or overall postoperative morbidity or mortality. However, the incidence of postoperative pneumonia, gastrointestinal bleeding, and intra-abdominal bleeding was significantly higher in the ESRD group. The 5-year disease-free survival rate was 44.3% in the ESRD group and 24.0% in the non-ESRD group (p=0.4483), and the 5-year survival rates were 76.4% and 65.1% (p=0.2291), respectively. HD and serum creatinine levels were not significant prognostic factors for survival and recurrence.

Conclusion: Hepatectomy for HCC in patients with ESRD on HD may be associated with increased risk of postoperative pneumonia, gastrointestinal bleeding, and intra-abdominal bleeding, but is feasible if careful surgical and perioperative management are provided.