Liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension.
JHEP Rep
; 3(1): 100190, 2021 Feb.
Article
em En
| MEDLINE
| ID: mdl-33294830
ABSTRACT
BACKGROUND & AIMS:
Liver resection (LR) in patients with hepatocellular carcinoma (HCC) and clinically significant portal hypertension (CSPH) defined as a hepatic venous pressure gradient (HVPG) ≥10 mmHg is not encouraged. Here, we reappraised the outcomes of patients with cirrhosis and CSPH who underwent LR for HCC in highly specialised liver centres.METHODS:
This was a retrospective multicentre study from 1999 to 2019. Predictors for postoperative liver decompensation and textbook outcomes were identified.RESULTS:
In total, 79 patients with a median age of 65 years were included. The Child-Pugh grade was A in 99% of patients, and the median model for end-stage liver disease (MELD) score was 8. The median HVPG was 12 mmHg. Major hepatectomies and laparoscopies were performed in 28% and 34% of patients, respectively. Ninety-day mortality and severe morbidity rates were 6% and 27%, respectively. Postoperative and persistent liver decompensation occurred in 35% and 10% of patients at 3 months. Predictors of liver decompensation included increased preoperative HVPG (p = 0.004), increased serum total bilirubin (p = 0.02), and open approach (p = 0.03). Of the patients, 34% achieved a textbook outcome, of which the laparoscopic approach was the sole predictor (p = 0.004). The 5-year overall survival and recurrence-free survival rates were 55% and 43%, respectively.CONCLUSIONS:
Patients with cirrhosis, HCC and HVPG ≥10 mmHg can undergo LR with acceptable mortality, morbidity, and liver decompensation rates. The laparoscopic approach was the sole predictor of a textbook outcome. LAYSUMMARY:
Patients with cirrhosis, hepatocellular carcinoma, and clinically significant portal hypertension (defined as a hepatic venous pressure gradient ≥10 mmHg) can undergo resection with acceptable mortality, morbidity, liver decompensation rates, and a textbook outcome. These results can be achieved in selected patients with preserved liver function, good general status, and sufficient remnant liver volume.
AFP, alpha-fetoprotein; ASA, American Society of Anesthesiologists; BCLC, Barcelona-Clinic Liver Cancer; CCI, Comprehensive Complication Index; CSPH, clinically significant portal hypertension; CT, computed tomography; Clinically significant portal hypertension; EASL, European Association for the Study of the Liver; HVPG, hepatic venous pressure gradient; Hepatectomy; Hepatic venous pressure gradient; LLR, laparoscopic liver resection; LR, liver resection; MELD, model for end-stage liver disease; PHT, portal hypertension; PVE, portal vein embolisation; Postoperative liver decompensation; TACE, transarterial chemoembolisation; Textbook outcome
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Base de dados:
MEDLINE
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article