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http://hdl.handle.net/2445/178335
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 López Ben, Santiago Figueras Felip, Joan Lim, Chetana |
Keywords: | Hepatectomia Hipertensió portal Període postoperatori Cirrosi hepàtica Hepatectomy 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. |
Note: | Reproducció del document publicat a: https://doi.org/10.1016/j.jhepr.2020.100190 |
It is part of: | Journal of Hepatology, 2020, vol. 3, num. 100190 |
URI: | http://hdl.handle.net/2445/178335 |
Related resource: | https://doi.org/10.1016/j.jhepr.2020.100190 |
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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