[The adverse effect of indirectly diagnosed portal hypertension on the complications and prognosis after hepatic resection of hepatocellular carcinoma].
OBJECTIVE
Surgical resection is considered as a curative treatment modality for patient with hepatocellular carcinoma (HCC). Since HCC often occurs in chronic liver disease, selecting optimal candidates based on the hepatic function reserve and the risk of hepatic decompensation after resection is important. In recent studies, clinically relevant portal hypertension including hepatic venous pressure gradient (HVPG) is considered as the best predictor of postoperative hepatic decompensation. However, since measuring HVPG requires an invasive procedure it is not widely used in practice. We aimed to evaluate whether the portal hypertension diagnosed indirectly could be a useful parameter for predicting postoperative prognosis.


METHODS
A total of 142 patients with HCC who had endoscopic examination, computed tomography and surgical resection from January 2001 to June 2004 were included in the study. We diagnosed portal hypertension indirectly by the presence of varices or splenomegaly with thrmobocytopenia. Postoperative complications and survival rate according to the presence of portal hypertension was studied.


RESULTS
The postoperative morbidity rate was 42.2%. The incidence of ascites and prolonged hyperbilirubinemia were significantly higher in portal hypertension group (ascites 43.8 vs. 10.3%, hyperbilirubinemia 20.3 vs. 1.3%, respectively, P<0.01). The cumulative 3-year recurrence-free survival rate showed no statistical difference between the two groups. However, the cumulative 3-year survival rate was significantly higher in the non-portal hypertension group (82.8% vs. 53%, respectively, P=0.014).


CONCLUSIONS
Indirectly diagnosed portal hypertension is correlated with the development of complications and poor prognosis after the surgical resection of HCC.
An
Min
M
Center for Liver Cancer Center, National Cancer Center, Goyang, Korea.
Park
Joong-Won
JW
Shin
Jeong A
JA
Choi
Joon Il
JI
Kim
Tae Hyun
TH
Kim
Seong-Hoon
SH
Lee
Woo Jin
WJ
Park
Sang-Jae
SJ
Hong
Eun Kyoung
EK
Kim
Chang-Min
CM
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000209:etiology; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D011379:Prognosis; D015996:Survival Rate