SURGICAL RESECTION OF HEPATOCELLULAR-CARCINOMA IN CIRRHOTIC-PATIENTS - PROGNOSTIC VALUE OF PREOPERATIVE PORTAL PRESSURE

Background & Aims: Although resection of hepatocellular carcinoma comp licating cirrhosis is restricted to patients with preserved liver func tion, postoperative hepatic decompensation develops in some patients. The aim of this study was to determine the value of increased portal p ressure in the development of post-operative hepatic decompensation. M ethods: Twenty-nine cirrhotic patients with Child-Pugh's class A disea se and hepatocellular carcinoma (all except one <5 cm) scheduled to un dergo resection were evaluated by conventional criteria and by a syste mic and hepatic hemodynamic study. Predictors of decompensation were a ssessed among a series of 44 clinical, analytical, tumoral, and hemody namic parameters. Results: Eleven patients had unresolved decompensati on 3 months after surgery. Bilirubin and blood ureic nitrogen levels, platelet count, wedged hepatic venous pressure, hepatic venous pressur e gradient, and indocyanine green intrinsic clearance were significant ly associated with unresolved decompensation, but only hepatic venous pressure gradient was significant in the multi-variate analysis (P = 0 .0001; odds ratio, 1.90; 95% confidence interval, 1.12-3.22). The preo perative gradient of patients with unresolved decompensation was highe r than that of patients without it (13.9 +/- 2.4 and 7.4 +/- 3.5 mm Hg , respectively; P < 0.001). Conclusions: Cirrhotics with increased por tal pressure are at high risk of hepatic decompensation after resectio n of hepatocellular carcinoma. Surgical resection should therefore be restricted to patients without portal hypertension.