Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 111 (4), 1018-22

Surgical Resection of Hepatocellular Carcinoma in Cirrhotic Patients: Prognostic Value of Preoperative Portal Pressure

Affiliations

Surgical Resection of Hepatocellular Carcinoma in Cirrhotic Patients: Prognostic Value of Preoperative Portal Pressure

J Bruix et al. Gastroenterology.

Abstract

Background & aims: Although resection of hepatocellular carcinoma complicating cirrhosis is restricted to patients with preserved liver function, postoperative hepatic decompensation develops in some patients. The aim of this study was to determine the value of increased portal pressure in the development of postoperative hepatic decompensation.

Methods: Twenty-nine cirrhotic patients with Child-Pugh's class A disease and hepatocellular carcinoma (all except one < 5 cm) scheduled to undergo resection were evaluated by conventional criteria and by a systemic and hepatic hemodynamic study. Predictors of decompensation were assessed among a series of 44 clinical, analytical, tumoral, and hemodynamic parameters.

Results: Eleven patients had unresolved decompensation 3 months after surgery. Bilirubin and blood ureic nitrogen levels, platelet count, wedged hepatic venous pressure, hepatic venous pressure gradient, and indocyanine green intrinsic clearance were significantly associated with unresolved decompensation, but only hepatic venous pressure gradient was significant, in the multivariate analysis (P = 0.0001; odds ratio, 1.90; 95% confidence interval, 1.12-3.22). The preoperative gradient of patients with unresolved decompensation was higher than that of patients without it (13.9 +/- 2.4 and 7.4 +/- 3.5 mm Hg, respectively; P < 0.001).

Conclusions: Cirrhotics with increased portal pressure are at high risk of hepatic decompensation after resection of hepatocellular carcinoma. Surgical resection should therefore be restricted to patients without portal hypertension.

Similar articles

See all similar articles

Cited by 178 PubMed Central articles

See all "Cited by" articles

Publication types

LinkOut - more resources

Feedback