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Annals of Surgery:
doi: 10.1097/SLA.0b013e3181b977a5
Original Articles

Is Portal Hypertension a Contraindication to Hepatic Resection?

Cucchetti, Alessandro MD*; Ercolani, Giorgio MD*; Vivarelli, Marco MD*; Cescon, Matteo MD*; Ravaioli, Matteo MD*; Ramacciato, Giovanni MD†; Grazi, Gian Luca MD*; Pinna, Antonio Daniele MD*

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Abstract

Background and Aims: The outcome of hepatic resection in cirrhotic patients has improved remarkably in recent years with improved surgical techniques and perioperative care; however, the role of portal hypertension is still uncertain. The aim of this study was to elucidate surgical outcomes of hepatectomy in patients with portal hypertension.

Methods: Data from 241 cirrhotic patients who underwent resection for hepatocellular carcinoma were retrospectively collected and analyzed: patients were divided into 2 groups according to the presence (n = 89) or absence (n = 152) of portal hypertension at the time of surgery. To overcome biases owing to the different distribution of covariates throughout the 2 groups, a one-to-one match was created using propensity score analysis: after match, intraoperative, and postoperative course and survival rates were analyzed.

Results: Patients with portal hypertension experienced worse preoperative liver function (mean model for end-stage liver disease [MELD] score, 9.5 ± 7.8 vs. 8.4 ± 1.3; P = 0.001) and survival rates (P = 0.008) in comparison to those without portal hypertension: after one-to-one matching, patients with (n = 78) and without portal hypertension (n = 78) had the same preoperative characteristics and showed the same intraoperative course, postoperative occurrence of liver failure, morbidity, length of in-hospital stay and survival rates (P = ns in all cases). The only predictors of postoperative liver failure were MELD score (P = 0.001) and extent of hepatectomy (P = 0.005).

Conclusions: Faced with the same MELD score and extent of hepatectomy planning, presence of portal hypertension should not be considered as a contraindication for hepatic resection in cirrhotic patients.

© 2009 Lippincott Williams & Wilkins, Inc.

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