Hepatic venous pressure gradient in the assessment of portal hypertension before liver resection in patients with cirrhosis

• Published in: British journal of surgery Vol. 99; no. 6; pp. 855 - 863
• Main Authors: Boleslawski, E., Petrovai, G., Truant, S., Dharancy, S., Duhamel, A., Salleron, J., Deltenre, P., Lebuffe, G., Mathurin, P., Pruvot, F. R.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-06-2012; Wiley
• Subjects: Aged; Biological and medical sciences; Carcinoma, Hepatocellular - physiopathology; Carcinoma, Hepatocellular - surgery; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Hepatectomy - methods; Humans; Hypertension, Portal - complications; Hypertension, Portal - diagnosis; Hypertension, Portal - physiopathology; Kaplan-Meier Estimate; Life Sciences; Liver Cirrhosis - physiopathology; Liver Cirrhosis - surgery; Liver Neoplasms - physiopathology; Liver Neoplasms - surgery; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Postoperative Complications - etiology; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Venous Pressure - physiology; Human; Gradient; Portal circulation disease; Digestive system; Liver; Cardiovascular disease; Hepatic disease; Patient; Hepatectomy; Vascular disease; Medicine; Cirrhosis; Treatment; Surgery; Portal hypertension; Digestive diseases; Hemodynamics; Venous pressure
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.8753

Background:
Preoperative measurement of hepatic venous pressure gradient (HVPG) is not performed routinely before hepatectomy in patients with cirrhosis, although it has been suggested to be useful. This study investigated whether preoperative HVPG values and indirect criteria of portal hypertension (PHT) predict the postoperative course in these patients.
Methods:
Between January 2007 and December 2009, consecutive patients with resectable hepatocellular carcinoma (HCC) in a cirrhotic liver were included in this prospective study. PHT was assessed by transjugular HVPG measurement and by classical indirect criteria (oesophageal varices, splenomegaly and thrombocytopenia). The main endpoints were postoperative liver dysfunction and 90‐day mortality.
Results:
Forty patients were enrolled. A raised HVPG was associated with postoperative liver dysfunction (median 11 and 7 mmHg in those with and without dysfunction respectively; P = 0·017) and 90‐day mortality (12 and 8 mmHg in those who died and survivors respectively; P = 0·026). Oesophageal varices, splenomegaly and thrombocytopenia were not associated with any of the endpoints. In multivariable analysis, body mass index, remnant liver volume ratio and preoperative HVPG were the only independent predictors of postoperative liver dysfunction.
Conclusion:
An increased HVPG was associated with postoperative liver dysfunction and mortality after liver resection in patients with HCC and liver cirrhosis, whereas indirect criteria of PHT were not. This study suggests that preoperative HVPG measurement should be measured routinely in these patients. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Good predictor of outcome