Is portal hypertension a contraindication to hepatic resection?
OBJECTIVE
The outcome of hepatic resection in cirrhotic patients has improved remarkably in recent years with improved surgical techniques and perioperative care; however, the role of portal hypertension is still uncertain. The aim of this study was to elucidate surgical outcomes of hepatectomy in patients with portal hypertension.


METHODS
Data from 241 cirrhotic patients who underwent resection for hepatocellular carcinoma were retrospectively collected and analyzed: patients were divided into 2 groups according to the presence (n = 89) or absence (n = 152) of portal hypertension at the time of surgery. To overcome biases owing to the different distribution of covariates throughout the 2 groups, a one-to-one match was created using propensity score analysis: after match, intraoperative, and postoperative course and survival rates were analyzed.


RESULTS
Patients with portal hypertension experienced worse preoperative liver function (mean model for end-stage liver disease [MELD] score, 9.5 +/- 7.8 vs. 8.4 +/- 1.3; P = 0.001) and survival rates (P = 0.008) in comparison to those without portal hypertension: after one-to-one matching, patients with (n = 78) and without portal hypertension (n = 78) had the same preoperative characteristics and showed the same intraoperative course, postoperative occurrence of liver failure, morbidity, length of in-hospital stay and survival rates (P = ns in all cases). The only predictors of postoperative liver failure were MELD score (P = 0.001) and extent of hepatectomy (P = 0.005).


CONCLUSIONS
Faced with the same MELD score and extent of hepatectomy planning, presence of portal hypertension should not be considered as a contraindication for hepatic resection in cirrhotic patients.
Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. aleqko@libero.it
Alessandro
A
Cucchetti
Giorgio
G
Ercolani
Marco
M
Vivarelli
Matteo
M
Cescon
Matteo
M
Ravaioli
Giovanni
G
Ramacciato
Gian Luca
GL
Grazi
Antonio Daniele
AD
Pinna
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000075202:Contraindications; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate