BACKGROUNDS & AIMS: To assess the relationship existing between hepatic venous pressure gradient (HVPG) and the occurrence of post-hepatectomy liver failure (PHLF) grade B/C after resection of hepatocellular carcinoma (HCC) and persistent worsening of liver function. METHODS: Data from 70 consecutive prospectively enrolled HCC patients undergoing resection were collected and analysed. PHLF grade B/C was defined by the International Study Group of Liver Surgery recommendations. The appearance of unresolved decompensation was also analysed. RESULTS: Postoperative and 90-day mortality were null. The median HVPG value was 9mmHg (range: 4-18) and the median Model for End-stage Liver Disease (MELD) score was 8 (range: 6-14); 34 patients had an HVPG ⩾10mmHg (48.6%). Forty-nine patients had an uneventful (Grade A) postoperative course, including 17 with an HVPG ⩾10mmHg (24.2% of 70 patients). Grade B complications occurred in 20 patients (3 with an HVPG <10mmHg and 17 with an HVPG ⩾10mmHg; p<0.001); only one grade C complication occurred in a patient with an HVPG <10mmHg, subsequently successfully undergoing liver transplantation. Median MELD score returned to preoperative values after a transient postoperative increase, regardless of the HVPG values; after three months, it returned to the preoperative of 8 in patients with an HVPG <10mmHg and of 9 in patients with an HVPG ⩾10mmHg (p=0.077 and 0.076 at paired test, respectively). CONCLUSIONS: The hepatic venous pressure gradient can be used before surgery to stratify the risk of PHLF but the proposed cut-off of 10mmHg excludes approximately one-quarter of the patients who would benefit from surgery without short to mid-term postoperative sequelae.

Cucchetti, A., Cescon, M., Golfieri, R., Piscaglia, F., Renzulli, M., Neri, F., et al. (2016). Hepatic venous pressure gradient in the preoperative assessment of patients with resectable hepatocellular carcinoma. JOURNAL OF HEPATOLOGY, 64(1), 79-86 [10.1016/j.jhep.2015.08.025].

Hepatic venous pressure gradient in the preoperative assessment of patients with resectable hepatocellular carcinoma

Neri, F;
2016

Abstract

BACKGROUNDS & AIMS: To assess the relationship existing between hepatic venous pressure gradient (HVPG) and the occurrence of post-hepatectomy liver failure (PHLF) grade B/C after resection of hepatocellular carcinoma (HCC) and persistent worsening of liver function. METHODS: Data from 70 consecutive prospectively enrolled HCC patients undergoing resection were collected and analysed. PHLF grade B/C was defined by the International Study Group of Liver Surgery recommendations. The appearance of unresolved decompensation was also analysed. RESULTS: Postoperative and 90-day mortality were null. The median HVPG value was 9mmHg (range: 4-18) and the median Model for End-stage Liver Disease (MELD) score was 8 (range: 6-14); 34 patients had an HVPG ⩾10mmHg (48.6%). Forty-nine patients had an uneventful (Grade A) postoperative course, including 17 with an HVPG ⩾10mmHg (24.2% of 70 patients). Grade B complications occurred in 20 patients (3 with an HVPG <10mmHg and 17 with an HVPG ⩾10mmHg; p<0.001); only one grade C complication occurred in a patient with an HVPG <10mmHg, subsequently successfully undergoing liver transplantation. Median MELD score returned to preoperative values after a transient postoperative increase, regardless of the HVPG values; after three months, it returned to the preoperative of 8 in patients with an HVPG <10mmHg and of 9 in patients with an HVPG ⩾10mmHg (p=0.077 and 0.076 at paired test, respectively). CONCLUSIONS: The hepatic venous pressure gradient can be used before surgery to stratify the risk of PHLF but the proposed cut-off of 10mmHg excludes approximately one-quarter of the patients who would benefit from surgery without short to mid-term postoperative sequelae.
Articolo in rivista - Articolo scientifico
Hepatic venous pressure gradient; Hepatocellular carcinoma; Portal hypertension; Surgery; Survival; Adult; Aged; Aged; 80 and over; Carcinoma; Hepatocellular; Female; Hepatic Veins; Humans; Liver Neoplasms; Male; Middle Aged; Prospective Studies; Severity of Illness Index; Venous Pressure; Preoperative Care; Hepatology
English
2016
64
1
79
86
reserved
Cucchetti, A., Cescon, M., Golfieri, R., Piscaglia, F., Renzulli, M., Neri, F., et al. (2016). Hepatic venous pressure gradient in the preoperative assessment of patients with resectable hepatocellular carcinoma. JOURNAL OF HEPATOLOGY, 64(1), 79-86 [10.1016/j.jhep.2015.08.025].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/440105
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