title: Influence of clinically significant portal hypertension on hepatectomy for hepatocellular carcinoma: a meta-analysis.
abstract: BACKGROUND
  Clinically significant portal hypertension (PHT) is considered as a contraindication for hepatectomy according to the guidelines of the European Association for Study of Liver and the American Association for Study of Liver Diseases. However, this issue remains controversial. Here we performed a meta- analysis to evaluate the impact of PHT on the results of hepatectomy for hepatocellular carcinoma (HCC).
  
  
  METHODS
  Cohort studies evaluating the impact of clinically significant PHT, defined as oesophageal varices and/ or splenomegaly associated with thrombocytopenia, on the results of hepatectomy for HCC were identified using a predefined search strategy. Summary risk ratios (RRs) and 95% confidence intervals (95% CIs) for PHT and outcomes after hepatectomy for HCC were calculated.
  
  
  RESULTS
  Seven cohort studies which including 574 cases with PHT and 1,354 cases without PHT were considered eligible for inclusion. The meta-analysis showed that, in all patients, pooled RRs of post-operative liver failure, post-operative ascites, peri-operative blood transfusion, operative mortality, 3- and 5-year overall survival associated with PHT were 2.23 (95% CI: 1.48-3.34, P=0.0001), 1.77 (95% CI: 1.19-2.64, P=0.005), 1.23 (95% CI: 1.03-1.49, P=0.03), 2.58 (95% CI: 1.12-5.96, P=0.03), 0.82 (95% CI: 0.75-0.88, P<0.00001) and 0.76 (95% CI: 0.69-0.85, P<0.00001), respectively. In subgroup analysis, similar results were found in Child-Pugh class A patients.
  
  
  CONCLUSIONS
  This meta-analysis suggests that presence of oesophageal varices and/or splenomegaly associated with thrombocytopenia is associated with higher rates of post-operative complications and poor long-term survival after hepatectomy for HCC.
authors.affiliation: Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China E-mail : wentianfu1471@163.com.
authors.forename: Yun-Hao
authors.initials: YH
authors.lastname: Tang
authors.forename: Wen-Jiang
authors.initials: WJ
authors.lastname: Zhu
authors.forename: Tian-Fu
authors.initials: TF
authors.lastname: Wen
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004932:Esophageal and Gastric Varices / Q000473:pathology; D006498:Hepatectomy; D006801:Humans; D006975:Hypertension, Portal / Q000473:pathology*; D008099:Liver / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D013163:Splenomegaly / Q000473:pathology; D013921:Thrombocytopenia / Q000473:pathology; D016896:Treatment Outcome