Association between preoperative albumin supplementation and postoperative outcomes in patients with hypoalbuminemia after hepatocellular carcinoma hepatectomy: REAL study.

BACKGROUND

Preoperative hypoalbuminemia is a risk factor for complications after hepatectomy for hepatocellular carcinoma (HCC). The impacts of preopeRative sErum Albumin Levels on postoperative outcomes in Chinese HCC Patients treated with surgical operation (REAL) studyaimed to evaluate the impact of preoperative human albumin administration on postoperative outcomes in patients with HCC and hypoalbuminemia undergoing hepatectomy.

METHODS

This retrospective study analyzed patients with HCC and preoperative hypoalbuminemia (serum albumin < 36 g/L) who underwent liver resection at Zhongshan Hospital, Fudan University. Patients were categorized into those who received albumin supplementation and those who did not. Surgical outcomes included durations of hospital and intensive care unit (ICU) stay, incidence and grade of posthepatectomy liver failure (PHLF), 30-day complication rates, and hospital mortality.

RESULTS

Patients with hypoalbuminemia who did not receive supplementation had significantly higher rates of PHLF grades A/B and 30-day complications compared with the normal albumin group, along with a shorter overall survival. However, patients with hypoalbuminemia who received supplementation achieved outcomes comparable to those of the normal albumin group, with no significant differences in hospital stay, ICU stay, PHLF grade distribution, or 30-day complication rates. Among patients with hypoalbuminemia, those who received albumin supplementation had a significantly lower PHLF rate. No in-hospital mortality occurred in any group.

CONCLUSION

Preoperative albumin supplementation in patients with hypoalbuminemiais associated with significantly improved postoperative outcomes in this retrospective cohort. These real-world findings provide preliminary evidence supporting targeted albumin supplementation to reduce surgical risk among such vulnerable patients. However, large prospective randomized controlled trials are still required to validate our conclusions before widespread clinical application.