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Influence of Clinically Significant Portal Hypertension on Hepatectomy for Hepatocellular Carcinoma: a Meta-analysis

  • Tang, Yun-Hao (Department of Liver Surgery, West China Hospital of Sichuan University) ;
  • Zhu, Wen-Jiang (Department of Liver Surgery, West China Hospital of Sichuan University) ;
  • Wen, Tian-Fu (Department of Liver Surgery, West China Hospital of Sichuan University)
  • Published : 2014.02.28

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 metaanalysis 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. Conclusion: 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.

Keywords

Portal hypertension;hepatectomy;hepatocellular carcinoma;meta-analysis

References

  1. van den Broek MA, Olde Damink SW, Dejong CH, et al (2008). Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment. Liver Int, 28, 767-80. https://doi.org/10.1111/j.1478-3231.2008.01777.x
  2. Schindl MJ, Redhead DN, Fearon KC, et al (2005). The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut, 54, 289-96. https://doi.org/10.1136/gut.2004.046524
  3. Stremitzer S, Tamandl D, Kaczirek K, et al (2011). Value of hepatic venous pressure gradient measurement before liver resection for hepatocellular carcinoma. Br J Surg, 98, 1752-8. https://doi.org/10.1002/bjs.7672
  4. Stroup DF, Berlin JA, Morton SC, et al (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA, 283, 2008-12. https://doi.org/10.1001/jama.283.15.2008
  5. Vizzutti F, Arena U, Romanelli RG, et al (2007). Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatology, 45, 1290-7. https://doi.org/10.1002/hep.21665
  6. Wong JS, Wong GL, Chan AW, et al (2013). Liver stiffness measurement by transient elastography as a predictor on posthepatectomy outcomes. Ann Surg, 257, 922-8. https://doi.org/10.1097/SLA.0b013e318269d2ec
  7. Yang Ping-hua, Qu Shu-ping, Cheng Zhang-jun, et al (2012). Hepatic resection for hepatocellular carcinoma with portal hypertension. Chinese Hepatology, 17, 626-9.
  8. Zhu W J, Huang C Y, Li C, et al (2013). Risk factors for early recurrence of hbv-related hepatocellular carcinoma meeting milan criteria after curative resection. Asian Pac J Cancer Prev, 14, 7101-6. https://doi.org/10.7314/APJCP.2013.14.12.7101
  9. Ziol M, Handra-Luca A, Kettaneh A, et al (2005). Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology, 41, 48-54. https://doi.org/10.1002/hep.20506
  10. Li SH, Guo ZX, Xiao CZ, et al (2013). Risk factors for early and late intrahepatic recurrence in patients with single hepatocellular carcinoma without macrovascular invasion after curative resection. Asian Pac J Cancer Prev, 14, 4759-63. https://doi.org/10.7314/APJCP.2013.14.8.4759
  11. Imamura H, Seyama Y, Kokudo N, et al (2003). One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg, 138, 1198-206. https://doi.org/10.1001/archsurg.138.11.1198
  12. Ishizawa T, Hasegawa K, Aoki T, et al (2008). Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology, 134, 1908-16. https://doi.org/10.1053/j.gastro.2008.02.091
  13. Kawano Y, Sasaki A, Kai S, et al (2008). Short- and longterm outcomes after hepatic resection for hepatocellular carcinoma with concomitant esophageal varices in patients with cirrhosis. Ann Surg Oncol, 15, 1670-6. https://doi.org/10.1245/s10434-008-9880-7
  14. Llovet JM, Fuster J, Bruix J (1999). Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology, 30, 1434-40. https://doi.org/10.1002/hep.510300629
  15. Parkin DM (2006). The global health burden of infectionassociated cancers in the year 2002. Int J Cancer, 118, 3030-44. https://doi.org/10.1002/ijc.21731
  16. Parkin DM, Bray F, Ferlay J, et al (2005). Global cancer statistics, 2002. CA Cancer J Clin, 55, 74-108. https://doi.org/10.3322/canjclin.55.2.74
  17. Ruzzenente A, Valdegamberi A, Campagnaro T, et al (2011). Hepatocellular carcinoma in cirrhotic patients with portal hypertension: Is liver resection always contraindicated?. World J Gastroenterol, 17, 5083-8. https://doi.org/10.3748/wjg.v17.i46.5083
  18. Santambrogio R, Kluger MD, Costa M, et al (2013). Hepatic resection for hepatocellular carcinoma in patients with Child- Pugh's A cirrhosis: is clinical evidence of portal hypertension a contraindication?. HPB, 15, 78-84. https://doi.org/10.1111/j.1477-2574.2012.00594.x
  19. Choi GH, Park JY, Hwang HK, et al (2011). Predictive factors for long-term survival in patients with clinically significant portal hypertension following resection of hepatocellular carcinoma. Liver Int, 31, 485-93. https://doi.org/10.1111/j.1478-3231.2010.02436.x
  20. Bruix J, Sherman M, Llovet JM, et al (2001). Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL Conference. European Association for the Study of the Liver. J Hepatol, 35, 421-30. https://doi.org/10.1016/S0168-8278(01)00130-1
  21. Capussotti L, Ferrero A, Vigan 'o L, et al (2006). Portal hypertension: contraindication to liver surgery? World J Surg, 30, 992-9. https://doi.org/10.1007/s00268-005-0524-9
  22. Chen X, Zhai J, Cai X, et al (2012). Severity of portal hypertension and prediction of postoperative liver failure after liver resection in patients with Child-Pugh grade A cirrhosis. Br J Surg, 99, 1701-10. https://doi.org/10.1002/bjs.8951
  23. Boleslawski E, Petrovai G, Truant S, et al (2012). Hepatic venous pressure gradient in the assessment of portal hypertension before liver resection in patients with cirrhosis. Br J Surg, 99, 855-63. https://doi.org/10.1002/bjs.8753
  24. Bruix J, Castells A, Bosch J, et al (1996). Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology, 111, 1018-22. https://doi.org/10.1016/S0016-5085(96)70070-7
  25. Cucchetti A, Ercolani G, Vivarelli M, et al (2009). Is portal hypertension a contraindication to hepatic resection? Ann Surg, 250, 922-8. https://doi.org/10.1097/SLA.0b013e3181b977a5
  26. Giannini EG, Savarino V, Farinati F, et al (2013). Influence of clinically significant portal hypertension on survival after hepatic resection for hepatocellular carcinoma in cirrhotic patients. Liver Int, 33, 1594-600.
  27. Hidaka M, Takatsuki M, Soyama A, et al (2012). Intraoperative portal venous pressure and long-term outcome after curative resection for hepatocellular carcinoma. Br J Surg, 99, 1284-9. https://doi.org/10.1002/bjs.8861
  28. Bruix J, Sherman M (2005). Management of hepatocellular carcinoma. Hepatology, 42, 1208-36. https://doi.org/10.1002/hep.20933

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