BACKGROUNDS & AIMS: To assess the relationship existing between hepatic venous pressure gradient (HVPG) and the occurrence of post-hepatectomy liver failure (PHLF) grade B/C after resection of hepatocellular carcinoma (HCC) and persistent worsening of liver function. METHODS: Data from 70 consecutive prospectively enrolled HCC patients undergoing resection were collected and analysed. PHLF grade B/C was defined by the International Study Group of Liver Surgery recommendations. The appearance of unresolved decompensation was also analysed. RESULTS: Postoperative and 90-day mortality were null. The median HVPG value was 9mmHg (range: 4-18) and the median Model for End-stage Liver Disease (MELD) score was 8 (range: 6-14); 34 patients had an HVPG ⩾10mmHg (48.6%). Forty-nine patients had an uneventful (Grade A) postoperative course, including 17 with an HVPG ⩾10mmHg (24.2% of 70 patients). Grade B complications occurred in 20 patients (3 with an HVPG <10mmHg and 17 with an HVPG ⩾10mmHg; p<0.001); only one grade C complication occurred in a patient with an HVPG <10mmHg, subsequently successfully undergoing liver transplantation. Median MELD score returned to preoperative values after a transient postoperative increase, regardless of the HVPG values; after three months, it returned to the preoperative of 8 in patients with an HVPG <10mmHg and of 9 in patients with an HVPG ⩾10mmHg (p=0.077 and 0.076 at paired test, respectively). CONCLUSIONS: The hepatic venous pressure gradient can be used before surgery to stratify the risk of PHLF but the proposed cut-off of 10mmHg excludes approximately one-quarter of the patients who would benefit from surgery without short to mid-term postoperative sequelae.

Hepatic venous pressure gradient in the preoperative assessment of patients with resectable hepatocellular carcinoma / Cucchetti, A; Cescon, M; Golfieri, R; Piscaglia, F; Renzulli, M; Neri, F; Cappelli, A; Mazzotti, F; Mosconi, C; Colecchia, A; Ercolani, G; Pinna, AD.. - In: JOURNAL OF HEPATOLOGY. - ISSN 0168-8278. - STAMPA. - 64:1(2016), pp. 79-86. [10.1016/j.jhep.2015.08.025]

Hepatic venous pressure gradient in the preoperative assessment of patients with resectable hepatocellular carcinoma

CUCCHETTI, ALESSANDRO;CESCON, MATTEO;GOLFIERI, RITA;PISCAGLIA, FABIO;RENZULLI, MATTEO;NERI, FLAVIA;MAZZOTTI, FEDERICO;MOSCONI, CRISTINA;COLECCHIA, ANTONIO;ERCOLANI, GIORGIO;PINNA, ANTONIO DANIELE
2016

Abstract

BACKGROUNDS & AIMS: To assess the relationship existing between hepatic venous pressure gradient (HVPG) and the occurrence of post-hepatectomy liver failure (PHLF) grade B/C after resection of hepatocellular carcinoma (HCC) and persistent worsening of liver function. METHODS: Data from 70 consecutive prospectively enrolled HCC patients undergoing resection were collected and analysed. PHLF grade B/C was defined by the International Study Group of Liver Surgery recommendations. The appearance of unresolved decompensation was also analysed. RESULTS: Postoperative and 90-day mortality were null. The median HVPG value was 9mmHg (range: 4-18) and the median Model for End-stage Liver Disease (MELD) score was 8 (range: 6-14); 34 patients had an HVPG ⩾10mmHg (48.6%). Forty-nine patients had an uneventful (Grade A) postoperative course, including 17 with an HVPG ⩾10mmHg (24.2% of 70 patients). Grade B complications occurred in 20 patients (3 with an HVPG <10mmHg and 17 with an HVPG ⩾10mmHg; p<0.001); only one grade C complication occurred in a patient with an HVPG <10mmHg, subsequently successfully undergoing liver transplantation. Median MELD score returned to preoperative values after a transient postoperative increase, regardless of the HVPG values; after three months, it returned to the preoperative of 8 in patients with an HVPG <10mmHg and of 9 in patients with an HVPG ⩾10mmHg (p=0.077 and 0.076 at paired test, respectively). CONCLUSIONS: The hepatic venous pressure gradient can be used before surgery to stratify the risk of PHLF but the proposed cut-off of 10mmHg excludes approximately one-quarter of the patients who would benefit from surgery without short to mid-term postoperative sequelae.
2016
Hepatic venous pressure gradient in the preoperative assessment of patients with resectable hepatocellular carcinoma / Cucchetti, A; Cescon, M; Golfieri, R; Piscaglia, F; Renzulli, M; Neri, F; Cappelli, A; Mazzotti, F; Mosconi, C; Colecchia, A; Ercolani, G; Pinna, AD.. - In: JOURNAL OF HEPATOLOGY. - ISSN 0168-8278. - STAMPA. - 64:1(2016), pp. 79-86. [10.1016/j.jhep.2015.08.025]
Hepatic venous pressure gradient in the preoperative assessment of patients with resectable hepatocellular carcinoma / Cucchetti, A; Cescon, M; Golfieri, R; Piscaglia, F; Renzulli, M; Neri, F; Cappelli, A; Mazzotti, F; Mosconi, C; Colecchia, A; Ercolani, G; Pinna, AD.. - In: JOURNAL OF HEPATOLOGY. - ISSN 0168-8278. - STAMPA. - 64:1(2016), pp. 79-86. [10.1016/j.jhep.2015.08.025]
Cucchetti, A; Cescon, M; Golfieri, R; Piscaglia, F; Renzulli, M; Neri, F; Cappelli, A; Mazzotti, F; Mosconi, C; Colecchia, A; Ercolani, G; Pinna, AD.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/559746
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