title: Influence of clinically significant portal hypertension on survival after hepatic resection for hepatocellular carcinoma in cirrhotic patients.
abstract: BACKGROUND
  The role of clinically significant portal hypertension on the prognosis of cirrhotic patients undergoing hepatic resection for hepatocellular carcinoma (HCC) is debated.
  
  
  OBJECTIVE
  In this study, our aim was to assess the role of clinically significant portal hypertension after hepatic resection for HCC in patients with cirrhosis.
  
  
  METHODS
  We assessed the prognostic role of the presence of clinically significant portal hypertension (oesophageal/gastric varices/portal hypertensive gastropathy or a platelet count <100 × 10(9) /L associated with splenomegaly) in 152 patients with compensated cirrhosis who underwent hepatic resection for HCC at the Italian Liver Cancer centres. Survival rates were assessed in the whole series, in the subgroup of Child-Pugh score 5 patients with uninodular HCC ≤ 5 cm, and in Child-Pugh score 5 patients with uninodular HCC ≤ 2 cm and normal bilirubin.
  
  
  RESULTS
  Median survival was similar in patients with and without clinically significant portal hypertension (79 vs 77 months, P = 0.686). Child-Pugh score 5 was the only variable significantly associated with survival by Cox multiple regression (P = 0.007). In Child-Pugh score 5 patients with single HCC ≤ 5 cm or in those with single HCC ≤ 2 cm and normal bilirubin, there was no survival difference between patients with and without clinically significant portal hypertension (median survival: 94 vs 78 months, P = 0.121 and >100 vs 86 months, P = 0.742).
  
  
  CONCLUSIONS
  Presence of clinically significant portal hypertension has no influence on survival of patients with well-compensated cirrhosis undergoing hepatic resection for HCC.
authors: Dipartimento di Medicina Interna, Unità di Gastroenterologia, Università di Genova, Genova, Italy.
authors: Edoardo G
authors: EG
authors: Giannini
authors: Vincenzo
authors: V
authors: Savarino
authors: Fabio
authors: F
authors: Farinati
authors: Francesca
authors: F
authors: Ciccarese
authors: Gianludovico
authors: G
authors: Rapaccini
authors: Mariella Di
authors: MD
authors: Marco
authors: Luisa
authors: L
authors: Benvegnù
authors: Marco
authors: M
authors: Zoli
authors: Franco
authors: F
authors: Borzio
authors: Eugenio
authors: E
authors: Caturelli
authors: Maria
authors: M
authors: Chiaramonte
authors: Franco
authors: F
authors: Trevisani
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D006975:Hypertension, Portal / Q000473:pathology*; D007558:Italy; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: hepatic venous pressure gradient; hepatocellular carcinoma; oesophageal varices; portal hypertension; surgery; survival; thrombocytopaenia