title: Hepatic venous pressure gradient in the assessment of portal hypertension before liver resection in patients with cirrhosis.
abstract: BACKGROUND
  Preoperative measurement of hepatic venous pressure gradient (HVPG) is not performed routinely before hepatectomy in patients with cirrhosis, although it has been suggested to be useful. This study investigated whether preoperative HVPG values and indirect criteria of portal hypertension (PHT) predict the postoperative course in these patients.
  
  
  METHODS
  Between January 2007 and December 2009, consecutive patients with resectable hepatocellular carcinoma (HCC) in a cirrhotic liver were included in this prospective study. PHT was assessed by transjugular HVPG measurement and by classical indirect criteria (oesophageal varices, splenomegaly and thrombocytopenia). The main endpoints were postoperative liver dysfunction and 90-day mortality.
  
  
  RESULTS
  Forty patients were enrolled. A raised HVPG was associated with postoperative liver dysfunction (median 11 and 7 mmHg in those with and without dysfunction respectively; P = 0·017) and 90-day mortality (12 and 8 mmHg in those who died and survivors respectively; P = 0·026). Oesophageal varices, splenomegaly and thrombocytopenia were not associated with any of the endpoints. In multivariable analysis, body mass index, remnant liver volume ratio and preoperative HVPG were the only independent predictors of postoperative liver dysfunction.
  
  
  CONCLUSIONS
  An increased HVPG was associated with postoperative liver dysfunction and mortality after liver resection in patients with HCC and liver cirrhosis, whereas indirect criteria of PHT were not. This study suggests that preoperative HVPG measurement should be measured routinely in these patients.
authors.affiliation: Service de Chirurgie Digestive et Transplantations, Hôpital Huriez, Centre Hospitalier Universitaire (CHU), Université Nord-de-France, Lille, France. emmanuel.boleslawski@chru-lille.fr
authors.forename: E
authors.initials: E
authors.lastname: Boleslawski
authors.forename: G
authors.initials: G
authors.lastname: Petrovai
authors.forename: S
authors.initials: S
authors.lastname: Truant
authors.forename: S
authors.initials: S
authors.lastname: Dharancy
authors.forename: A
authors.initials: A
authors.lastname: Duhamel
authors.forename: J
authors.initials: J
authors.lastname: Salleron
authors.forename: P
authors.initials: P
authors.lastname: Deltenre
authors.forename: G
authors.initials: G
authors.lastname: Lebuffe
authors.forename: P
authors.initials: P
authors.lastname: Mathurin
authors.forename: F R
authors.initials: FR
authors.lastname: Pruvot
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000503:physiopathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D016896:Treatment Outcome; D014690:Venous Pressure / Q000502:physiology