Impacto y resultados de la resección hepática por carcinoma hepatocelular en los pacientes con hipertensión portal clínicamente significativa

Abstract

Purpose: Clinically significant portal hypertension (CSPH), although not a contraindication for liver resection in cirrhosis, is considered a determinant prognostic factor for post-surgical outcomes. This study aims to investigate the effects of CSPH on short and long-term results after hepatic resection for hepatocellular carcinoma (HCC). Methods: Single-center retrospective analysis of 126 consecutive hepatic resections for HCC in Child-Pugh A patients, performed between 2008 and2018. Patients were divided according to the presence of CSPH, defined as a hepatic venous pressure gradient ≥ 10 mmHg. To overcome selection bias, 42 patients with CSPH were matched through propensity score with 42 patients without CSPH. Intraoperative and post-operative outcomes, along with overall and disease-free survival, were compared between the matched groups. Results: Liver decompensation was four-fold in the CSPH group (28.6% vs. 7.1%, p = 0.010), while rate of severe complications, including 90-days mortality, was not statistically different between patients with and without CSPH. Overall and recurrence-free survival was not inferior in patients with CSPH compared to non-CSPH group. Conclusions: The present study has demonstrated acceptable outcomes of liver resection for HCC in carefully selected Child-Pugh A cirrhotic patients, even in the presence of elevated portal pressure.

The Impact of Portal Hypertension Assessment Method on the Outcomes of Hepatocellular Carcinoma Resection

“…Finally, 9 articles fulfilled the inclusion criteria. 6,[26][27][28][29][30][31][32][33] Six propensity score matched studies, one case-matched study, and 2 prospective-controlled studies involving 1124 patients were included. The studies were conducted in both Eastern (ie, China) and Western (ie, Spain, Italy, and France) centers.…”

“…Five studies used indirect criteria to consider the presence of PHT, [26][27][28]31,32 and 4 used invasive measurement using the HVPG. 6,29,30,33 The assessment of the quality of the studies and the score in each of the 8 domains of the Newcastle-Ottawa Scale are specified in eTable 4 (page 16 of the Supplementary Material, Supplemental Digital Content 1, http://links.lww.com/SLA/E978). Two authors reviewed all studies (D.A.…”

“…4A, Supplemental Digital Content 2, http://links. lww.com/SLA/E979) [28][29][30][31][32][33] was observed between patients with and without PHT.…”

“…Four studies [29][30][31][32] included 248 patients who underwent resection using a minimally invasive approach (112 with PHT and 136 without PHT). The remaining 5 studies 6,[26][27][28]33 reported postoperative and survival outcomes of 876 patients (437 with PHT and 439 without PHT) who underwent resection using an open approach (in > 97% of the patients). For patients who underwent OLR, PHT significantly increased the risk of overall complications (OR: 1.55; 95% CI: 1.…”

The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in Treating Portal Hypertension in Patients with Hepatocellular Carcinoma

“…Thus, patients with CSPH should be referred to highly qualified centers for hepatology and hepato-biliary surgery [ 57 ]. Another analysis by Cortese et al [ 58 ] showed that in a cohort of patients affected by liver cirrhosis and HCC and preserved liver function (Child–Pugh score A and no previous decompensations), the number of postoperative decompensation episodes was four-fold higher among patients with an HVPG > 10 mmHg. Of mention, this issue was also described as having acceptable percentages of mortality (<5%) and severe liver disfunction rate (<25%).…”