Portal Venous Pressure In Patients With Liver Failure After Liver Resection And Survival

Part1The value of portal venous pressure on prediction of posthepatectomy liver failureBackground&Aims:Child-Pugh A patients with clinical evidence of portal hypertension are likely to develop posthepatectomy liver failure (PHLF). Whether such patients are suitable for partial hepatectomy is controversial. This research program was to explore the impact of portal venous pressure (PVP) on PHLF and the possibility of stratifying Child-Pugh A patients using clinical data.Methods:This prospective cohort study included236consecutive Child-Pugh A patients who underwent partial hepatectomy. The risk factors of PHLF were analyzed by univariate and multivariate analyses and their predictive capacities were determined using receiver operating characteristic curves.Results:Seventy-three of236patients developed PHLF (30.9%), with persistent PHLF in12patients (5.1%). Four patients (1.7%) died from PHLF within3months after surgery. Multivariate analysis showed PVP (OR=1.13per1cm H2O increase, P<0.001) was an independent predictor of PHLF. Using clinical signs of clinically significant portal hypertension (CSPH), the Child-Pugh A patients could be sub-classified in three groups: no-CSPH, mild-CSPH and severe-CSPH. The incidences of PHLF and persistent PHLF in the severe-CSPH groups were significantly higher than the other two groups (P<0.05). Severe-CSPH (OR=32.2, P=0.003) and a preoperative neutrophil-lymphocyte ratio (NLR)＞2.8(OR=51.8, P=0.002) were independent factors affecting the incidence of persistent PHLF.Conclusion:Child-Pugh A patients could be further sub-classified. Patients with severe-CSPH or a NLR≥2.8were more likely to develop persistent PHLF after partial hepatectomy. Part2The impact of clinically significant portal hypertension on long-term survival of cirrhotic patients with HCC after liver resectionBackground and aim:Liver resection for hepatocellular carcinoma (HCC) is accepted as the effective and safe treatment modality in cirrhotic patients with preserved liver function. However, the long term survial of patients with clinically significant portal hypertension (CSPH) is uncertain. On the basis of our previous study, we further investigated the long term survival of patients with different stratification of CSPH.Methods:A total of124cases of radical resection of Child-Pugh A cirrhotic patients with HCC were studied between2009and2011in Eastern Hepatobiliary Surgery Hospital in Shanghai, China. Using Kaplan-Meier method calculate the survival rate; survival curves were statistically compared using log-rank test. Multivariate analysis with Cox’regression model was performed to analyze the independent prognostic risk factors of patients’ survival.Results:CSPH was present in61(49.2%) patients. The PVP level in severe-CSPH group was significantly higher than those in no-and mild-CSPH groups (25vs.14.5cmH2O, P <0.001and25vs.16cmH20, P<0.001; repectively). Long-term overall survival was poorer in the severe-CSPH group than in no-or mild-CSPH group. The1-,2-3-year overall survival rates were67.7%,57.7%,8.5%in severe-CSPH group,82.4%,76.5%,76.5%in mild-CSPH group (P=0.049), and88.7%,75.2%,75.2%in no-CSPH group respectively (P=0.007), whereas overall survival showed no significant difference between no-and mild-CSPH group (P=0.745). Multivariate analysis showed that severe-CSPH and major hepatectomy were independent adverse prognostic factors for overall survival, and NLR and TNM stage were independent adverse prognostic factors for disease-free survival.Conclusion:Child-Pugh class A cirrhotic patients with CSPH have different prognosis. The overall survival after hepatectomy of patients with severe-CSPH was significantly lower than that of patients with no-or mild-CSPH. Whereas patients with no-and mild-CSPH showed the similar overall survival.