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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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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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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. Liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension. _Journal of Hepatology_. 2020. Vol. 3, núm. 100190. [consulta: 21 de gener de 2026]. ISSN: 0168-8278. [Disponible a: https://hdl.handle.net/2445/178335]