Scientific publications

The Impact of Portal Hypertension Assessment Method on the Outcomes of Hepatocellular Carcinoma Resection

Dec 21, 2023 | Magazine: Annals of Surgery

Daniel Aliseda  1 , Gabriel Zozaya  1   2 , Pablo Martí-Cruchaga  1   2 , Ignacio Herrero  2   3 , Mercedes Iñarrairaegui  2   3 , Josepmaría Argemí  2   3 , Antonio Martínez De La Cuesta  2   4 , Nuria Blanco  1 , Lucas Sabatella  1 , Bruno Sangro  2   3 , Fernando Rotellar  1   2

Objective: Examine PHT impact on postoperative and survival outcomes in HCC patients after LR, specifically exploring distinctions between indirect signs and invasive measurements of PHT.

Summary background data: PHT has historically discouraged LR in individuals with HCC, due to the elevated risk of morbidity, including liver decompensation (LD).

Methods: A systematic review was conducted using 3 databases to identify prospective controlled and matched cohort studies until December 28, 2022. Focus on comparing postoperative outcomes (mortality, morbidity, and liver-related complications) and OS in HCC patients with and without PHT undergoing LR. Three meta-analysis models were utilized: For aggregated data (fixed-effects inverse variance model), for patient-level survival data (one-stage frequentist meta-analysis with gamma-shared frailty Cox proportional hazards model), and for pooled data (Freeman-Tukey exact and double arcsine method).

Results: Nine studies involving 1,124 patients were analyzed. Indirect signs of PHT were not significantly associated with higher mortality, overall complications, PHLF or LD. However, LR in patients with HVPG ≥10 mmHg significantly increased the risk of overall complications, PHLF and LD. Despite elevated risks, the procedure resulted in a 5-year OS rate of 55.2%. Open LR significantly increased the risk of overall complications, PHLF and LD. Conversely, PHT did not show a significant association with worse postoperative outcomes in MILR.

Conclusions: LR with indirect PHT signs poses no increased risk of complications. Yet, in HVPG ≥10 mmHg patients, LR increases overall morbidity and liver-related complications risk. Transjugular HVPG assessment is crucial for LR decisions. MI approach seems to be vital for favorable outcomes, especially in HVPG ≥10 mmHg patients.

CITATION  Ann Surg. 2023 Dec 21.  doi: 10.1097/SLA.0000000000006185