Portal Vein Pressure Change Predicts Posthepatectomy Liver Failure Following Right Lobectomy

Abstract

The aim of this study was to evaluate the usefulness of intraoperative portal venous pressure (PVP) as a predictor of posthepatectomy liver failure (PHLF). Hepatic functional reserve is typically evaluated by using parameters such as albumin level, platelet count, prothrombin activity level, or indocyanine green retention rate at 15 minutes. Low hepatic functional reserve can enhance the risk of PHLF. We retrospectively analyzed the outcomes of 35 patients who underwent right lobectomy and intraoperative PVP measurements between April 2004 and August 2012. According to preoperative prediction scores, all patients were within a safe limit for right lobectomy. The patients were grouped into uncomplicated (n ¼ 22) and PHLF (n ¼ 13) groups by postoperative course. PHLF was defined as grade B or C according to International Study Group of Liver Surgery criteria. Patient background, intraoperative bleeding, operative time, and PVP elevation after hepatectomy (DPVP) grade were compared between the groups. No cases of in-hospital death occurred. Univariate analysis revealed significant differences in preoperative white blood counts, intraoperative bleeding, and DPVP between the groups (P , 0.05). The DPVP was an independent risk factor on multivariate analysis. A DPVP .3 cmH 2 O was associated with PHLF at 69.2% sensitivity and 90.9% specificity. Following right lobectomy, a DPVP .3 cmH 2 O indicates a risk of PHLF and warrants careful postoperative management.

A systematic review of the impact of portal vein pressure changes on clinical outcomes following hepatic resection

“…See Table 2. Following the original literature search 10 studies (with 712 patients) from a pool of 68 studies were selected [6][7][8][9][10][11][12][13][14][15] [Fig. 1].…”

“…Following resection, nine out of ten studies reported [6][7][8][9][10][11][12]14,15 absolutes values for PVP (n = 682 patients) and one study (n = 30) reported a delta increment. 13 These data included patients with minor (n = 162) and major resections (n = 550) and with or without cirrhosis (424/682 no cirrhosis).…”

“…Six studies found a relationship between PVP and the PLF. 6,7,10,11,15 Morbidity, mortality and PVP See Table 4. Six studies 6,9,[11][12][13]15 reported significantly increased morbidity (Clavien Dindo complications III or higher) when post-resection PVP was elevated, for example ascites, 9,15 hyperbilirubinemia 13,15 or a prolonged INR.…”

“…Techniques to directly measure PVP included: direct PV puncture; 6,7,12-14 trans-mesenteric vein PV cannulation 8,15 or transteres ligament PV cannulation. [9][10][11] Units used were mmHg when transducers were interrogated or cmH 2 0 if a column of water or saline employed (1 cmH 2 0 = .735 mmHg).…”

“…4,5 More recently, in patients without cirrhosis elevated post-resection PVP has been shown to predict PLF, death and other complications after a major liver resection. 6,7 Intraoperative measurement of PVP therefore might contribute to accurate risk assessment of PLF and provides a potential therapeutic target for pharmacological [6][7][8][9][10][11][12][13][14][15] or surgical (reversible PV diameter modulation, splenic artery ligation, shunting or splenectomy) [16][17][18][19] PVP modulation. The aim of the present study was to systematically review the relationship between post-resection PVP and clinical outcomes, specifically, PLF in patients undergoing LR.…”