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Data de publicació

2020-10-08

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cc-by-nc-nd (c) Azoulay, Daniel et al., 2020
Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/178335

Liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension

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Recurs relacionat

https://doi.org/10.1016/j.jhepr.2020.100190

Resum

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.

Matèries

Hepatectomia, Hipertensió portal, Període postoperatori, Cirrosi hepàtica

Matèries (anglès)

Hepatectomy, Portal hypertension, Postoperative period, Hepatic cirrhosis

Citació

Col·leccions

Articles publicats en revistes (Ciències Clíniques)
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

Citació

AZOULAY, Daniel, et al. Liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension. Journal of Hepatology. 2020. Vol. 3, núm. 100190. ISSN 0168-8278. [consulta: 8 de maig de 2026]. Disponible a: https://hdl.handle.net/2445/178335

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