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Title: Liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension
Author: Azoulay, Daniel
Ramos Rubio, Emilio
Casellas Robert, Margarida
Salloum, Chady
Lladó Garriga, Laura
Nadler, Roy
Busquets Barenys, Juli
Caula Freixa, Celia
Mils, Kristel
Lopez Ben, Santiago
Figueras Felip, Joan
Lim, Chetana
Keywords: Hepatectomia
Hipertensió portal
Període postoperatori
Cirrosi hepàtica
Portal hypertension
Postoperative period
Hepatic cirrhosis
Issue Date: 8-Oct-2020
Publisher: Elsevier
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 reap praised 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.
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It is part of: Journal of Hepatology, 2020, vol. 3, num. 100190
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ISSN: 0168-8278
Appears in Collections:Articles publicats en revistes (Ciències Clíniques)
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

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