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Portal hypertension increased mortality in patients with cirrhosis after surgery for HCC

The presence of clinically significant portal hypertension in patients with cirrhosis increased mortality and decompensation after surgery for hepatocellular carcinoma, according to recent study data.

“Results of this systematic review and meta-analysis indicate that the presence of [clinically significant portal hypertension] negatively impacts on the postoperative outcomes of patients with compensated cirrhosis undergoing surgery for [hepatocellular carcinoma], thus validating the recommendations contained in current international guidelines,” the researchers wrote.

The researchers chose 11 studies with 1,737 patients with cirrhosis for the systematic review and analyses after performing a systematic search of the MEDLINE database. All the studies consisted of postoperative data related to 3- and 5-year mortality and postoperative clinical decompensation, according to the research.

Patients with clinically significant portal hypertension (CSPH) showed increased risk of 3-year (pooled OR=2.09; 95% CI, 1.52-2.88) and 5-year mortality (pooled OR=2.07; 95% CI, 1.51-2.84) postoperatively compared with patients who did not have CSPH. Of these patients, 491 died at 3 years and 694 died at 5 years. Patients with CSPH also had an increased risk of postoperative clinical decompensation compared with patients without CSPH (pooled OR=3.04; 95% CI, 2.02-4.59).

“These results reinforce that the existence of CSPH should be investigated before indicating surgery to correctly stratify postoperative risk of liver-related events,” the researchers concluded. “[Additionally], the [hepatic venous pressure gradient] should be used in this population to diagnose CSPH, the only exception being those patients known to have [gastroesophageal varices], because this represents a specific indicator of the presence of CSPH.”  

Disclosure: Bruix reports consulting for and receiving grants from Bayer. See the study for a full list of the researchers’ relevant financial disclosures