Hepatic resection for hepatocellular carcinoma in patients with Child–Pugh's A cirrhosis: is clinical evidence of portal hypertension a contraindication?

Abstract

PHTN should not be considered an absolute contraindication to a hepatectomy in cirrhotic patients. Patients with PHTN have short- and long-term results similar to patients with normal portal pressure. A limited hepatic resection for early-stage tumours is an option for Child-Pugh class A5 patients with PHTN.

Influence of Clinically Significant Portal Hypertension on Hepatectomy for Hepatocellular Carcinoma: a Meta-analysis

“…The following outcomes were presented in at least 3 studies and extracted for combined analysis: post-operative liver failure, post-operative ascites, perioperative blood transfusion, operative mortality, 3-and 5-year survival. Six included studies divided patients according to Child-Pugh classification and did subgroup analysis of Child-Pugh class A patients (Capussotti et al, 2006;Ishizawa et al, 2008;Choi et al, 2011;Ruzzenente et al, 2011;Yang et al, 2012;Santambrogio et al, 2013). Therefore, we conduct a subgroup meta-analysis to evaluate the impact of clinically significant PHT on the results of hepatectomy for HCC in Child-Pugh class A patients separately.…”

“…Short-term outcomes: Four included studies (Capussotti et al, 2006;Cucchetti et al, 2009;Choi et al, 2011;Santambrogio et al, 2013) reported post-operative liver failure, three (Capussotti et al, 2006;Choi et al, 2011;Santambrogio et al, 2013) reported post-operative ascites, five (Capussotti et al, 2006;Cucchetti et al, 2009;Choi et al, 2011;Yang et al, 2012;Santambrogio et al, 2013) reported peri-operative blood transfusion, and three (Capussotti et al, 2006;Choi et al, 2011;Santambrogio et al, 2013) reported operative mortality. The P values of heterogeneity tests were 0.82, 0.84, 0.21, and 0.74, respectively.…”

“…Of these, two studies were excluded (one did not present usable data (Giannini et al, 2013); samples of two studies were partially overlapped (Imamura et al, 2003;Ishizawa et al, 2008), so only the newest one was included (Ishizawa et al, 2008). As a result, a total of 7 cohort studies (Capussotti et al, 2006;Ishizawa et al, 2008;Cucchetti et al, 2009;Choi et al, 2011;Ruzzenente et al, 2011;Yang et al, 2012;Santambrogio et al, 2013) which including 574 cases with PHT and 1354 cases without PHT were considered eligible for inclusion based on MOOSE (Metaanalysis Of Observational Studies in Epidemiology) guidelines (Stroup et al, 2000). The flow chart of selection of studies and reasons for exclusion is presented in Figure 1.…”

“…Via steps of screening the title and reading the abstract, 9 studies were identified (Imamura et al, 2003;Capussotti et al, 2006;Ishizawa et al, 2008;Cucchetti et al, 2009;Choi et al, 2011;Ruzzenente et al, 2011;Yang et al, 2012;Santambrogio et al, 2013;Giannini et al, 2013). Of these, two studies were excluded (one did not present usable data (Giannini et al, 2013); samples of two studies were partially overlapped (Imamura et al, 2003;Ishizawa et al, 2008), so only the newest one was included (Ishizawa et al, 2008).…”

Assessment of preoperative liver function in patients with hepatocellular carcinoma: The albumin-indocyanine green evaluation (ALICE) grade.

“…Many attempts have been made to develop criteria of liver function for safe liver resection [2][3][4][5]. Portal hypertension (PH) is listed as a contraindication for liver resection in Western countries, and the indocyanine green (ICG) test is widely used in East Asian countries to decide whether patients with HCC are candidates for surgery [6][7][8][9][10][11][12][13].…”