Ann Hepatobiliary Pancreat Surg.  2016 Nov;20(4):159-166. 10.14701/ahbps.2016.20.4.159.

Impact of clinically significant portal hypertension on surgical outcomes for hepatocellular carcinoma in patients with compensated liver cirrhosis: a propensity score matching analysis

Affiliations
  • 1Department of Surgery, Kyungpook National University Hospital, Daegu, Korea.
  • 2Department of Surgery, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea. kwonhj95@naver.com

Abstract

BACKGROUNDS/AIMS
The roles of portal hypertension (PHT) on the postoperative course after hepatectomy are still debated. The aim of this study was to evaluate surgical outcomes of hepatectomy in patients with PHT.
METHODS
Data from 152 cirrhotic patients who underwent hepatectomy for hepatocellular carcinoma (HCC) were collected retrospectively. Patients were divided into two groups according to the preoperative presence of PHT as follows: 44 patients with PHT and 108 without PHT. Propensity score matching (PSM) analysis was used to overcome selection biases.
RESULTS
There were no significant differences in morbidity (56.8% vs. 51.9%, p=0.578) and 90-days mortality (4.5% vs. 4.6%, p=0.982) between the two groups. Post-hepatectomy liver failure (PHLF) was not significantly different between the two groups (43.2% vs. 35.2%, p=0.356). Patients without PHT had a better 5-year disease-free survival than those with PHT, although the difference did not reach statistical significance (30.9% vs. 17.2%, p=0.081). Five-year overall survivals were not significantly different between the two groups (46.6% vs. 54.9%, p=0.724). Repeat analyses after PSM showed similar rates of morbidity (p=0.819), mortality (p=0.305), PHLF (p=0.648), disease-free survival (p=0.241), and overall survival (p=0.619). The presence of PHT was not associated with either short-term or long-term poor surgical outcomes.
CONCLUSIONS
Child-Pugh A and B patients with PHT have surgical outcomes similar to those without PHT. Hepatectomy can be safely performed and can also be considered as a potentially curative treatment in HCC patients with PHT.

Keyword

Portal hypertension; Hepatocellular carcinoma; Hepatectomy; Complication; Prognosis

MeSH Terms

Carcinoma, Hepatocellular*
Disease-Free Survival
Hepatectomy
Humans
Hypertension, Portal*
Liver Cirrhosis*
Liver Failure
Liver*
Mortality
Prognosis
Propensity Score*
Retrospective Studies
Selection Bias

Figure

  • Fig. 1 Propensity score matching (PSM) process. (A) Parallel line plot of the standardized difference in means before and after PSM in hepatocellular carcinoma patients with and without portal hypertension (PHT). As the standardized difference in means was reduced, the covariate balance was improved in the matched samples. (B) Dot plot of the propensity scores of patients in the PHT and the non-PHT groups showing individual units in the dataset and whether they were matched or discarded.

  • Fig. 2 Kaplan-Meier survival curves of the population undergoing hepatectomy for hepatocellular carcinoma with and without portal hypertension (PHT). (A) and (B) show disease-free survival before and after propensity score matching, respectively. (C) and (D) show overall survival before and after propensity score matching, respectively (blue line, without PHT; and green line, with PHT).


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