Impact of clinically significant portal hypertension on surgical outcomes for hepatocellular carcinoma in patients with compensated liver cirrhosis: a propensity score matching analysis

Abstract

Backgrounds/AimsThe roles of portal hypertension (PHT) on the postoperative course after hepatectomy are still debated. The aim of this study was to evaluate surgical outcomes of hepatectomy in patients with PHT.MethodsData from 152 cirrhotic patients who underwent hepatectomy for hepatocellular carcinoma (HCC) were collected retrospectively. Patients were divided into two groups according to the preoperative presence of PHT as follows: 44 patients with PHT and 108 without PHT. Propensity score matching (PSM) analysis was used to overcome selection biases.ResultsThere were no significant differences in morbidity (56.8% vs. 51.9%, p=0.578) and 90-days mortality (4.5% vs. 4.6%, p=0.982) between the two groups. Post-hepatectomy liver failure (PHLF) was not significantly different between the two groups (43.2% vs. 35.2%, p=0.356). Patients without PHT had a better 5-year disease-free survival than those with PHT, although the difference did not reach statistical significance (30.9% vs. 17.2%, p=0.081). Five-year overall survivals were not significantly different between the two groups (46.6% vs. 54.9%, p=0.724). Repeat analyses after PSM showed similar rates of morbidity (p=0.819), mortality (p=0.305), PHLF (p=0.648), disease-free survival (p=0.241), and overall survival (p=0.619). The presence of PHT was not associated with either short-term or long-term poor surgical outcomes.ConclusionsChild-Pugh A and B patients with PHT have surgical outcomes similar to those without PHT. Hepatectomy can be safely performed and can also be considered as a potentially curative treatment in HCC patients with PHT.

The power of tumor sizes in predicting the survival of solitary hepatocellular carcinoma patients

“…Numerous factors have been identified as prognostic indicators and are incorporated into various staging systems. These factors include lesion numbers, vascular invasion, portal hypertension, regional lymph node metastases, distant metastases, laboratory examination indicators such as serum albumin and bilirubin, and so on. Tumor size has been included in several staging systems, such as the Liver Cancer Study Group of Japan TNM staging system and the Hong Kong staging system .…”

Predictive power of splenic thickness for post-hepatectomy liver failure in HBV-associated hepatocellular carcinoma patients

“…The prevalence of histologic cirrhosis is high among patients with hepatitis B virus (HBV) and hepatitis C virus (HCV) infections [ 6 ]. In Asia, approximately 80% of HCC cases occur in patients with cirrhosis derived from chronic HBV infection [ 7 ].These co-morbidities, along with portal hypertension [ 8 ], are associated with increased morbidity or mortality because of a significant impairment in liver function [ 9 ]. In addition, a palpable or enlarged spleen is common in these patients and is considered as an independent predictor of the presence of large esophageal varices, which carry a high risk of bleeding and allow the clinical progression of cirrhosis to be monitored [ 10 ].…”