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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*

doi: 10.1097/SLA.0b013e3181b977a5
Original Articles

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.

To elucidate the outcome of cirrhotic patients with portal hypertension undergoing hepatectomy, data from 241 patients undergoing resection for hepatocellular carcinoma were reviewed and properly matched: patients with portal hypertension experienced worse preoperative liver function and survival rates; however, after adequate match, showed the same clinical course and survivals as those without portal hypertension. The only predictors of postoperative liver failure were model for end-stage liver disease score and extent of hepatectomy.

From the *Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; and †General Surgery D, Sant'Andrea Hospital, University “La Sapienza,” Rome, Italy.

Reprints: Alessandro Cucchetti, MD, Policlinico Sant'Orsola-Malpighi, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.