Open AccessIntraoperative portal venous pressure and long‐term outcome after curative resection for hepatocellular carcinoma
Author(s) -
Hidaka M.,
Takatsuki M.,
Soyama A.,
Tanaka T.,
Muraoka I.,
Hara T.,
Kuroki T.,
Kanematsu T.,
Eguchi S.
Publication year - 2012
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.8861
Subject(s) - medicine , hepatocellular carcinoma , portal hypertension , laparotomy , portal venous pressure , survival rate , gastroenterology , surgery , resection , overall survival , carcinoma , cirrhosis
Background: Outcomes of liver resection for hepatocellular carcinoma (HCC) have improved owing to better surgical techniques and patient selection. Portal hypertension may influence outcome but the preoperative definition and role of portal hypertension are far from clear. The aim of this study was to elucidate the influence of portal venous pressure (PVP) measured directly during surgery on outcomes of liver resection in patients with HCC. Methods: Patients who had resection of HCC between 1997 and 2009, and who underwent direct measurement of PVP immediately after laparotomy were enrolled. These patients were divided into groups with high (at least 20 cmH 2 O) and low (less than 20 cmH 2 O) PVP. The influence of PVP on overall and recurrence‐free survival was analysed and prognostic factors were identified. Results: A total of 177 patients were enrolled, 129 in the low‐PVP group and 48 in the high‐PVP group. The 5‐year overall survival rate (63·7 versus 31 per cent; P < 0·001) and recurrence‐free survival rate (52·5 versus 12 per cent; P < 0·001) were significantly higher in patients with low PVP. In multivariable analysis, two or more tumours, tumour diameter at least 5 cm, high PVP, grade B liver damage and Hepatic Activity Index (HAI) grade 7 or more were significant predictors of poorer survival after liver resection. Two or more tumours, tumour diameter at least 5 cm and HAI grade 7 or more were significant predictors of poorer recurrence‐free survival. Conclusion: High PVP was associated with poor long‐term outcome after liver resection for HCC. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.