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Liver resection for liver cancer safe in patients with portal hypertension

Portal hypertension did not negatively affect survival rates in patients who underwent liver resection for hepatocellular carcinoma, according to recently published data. While multiple tumors did affect survival, researchers considered the survival benefit from liver resection in these patients to be acceptable.

“Consistent with the previous data, the presence of multiple HCCs was one of the independent factors for overall survival in the present study,” Takao Ohkubo, MD, from the Nihon University School of Medicine, Japan, and colleagues wrote. “We assume that patients with favorable liver function could have survival benefits by liver resection for multiple tumors, although liver resection for patients with multiple HCC is a palliative treatment, and such patients should not be contraindicated.”

Between 2001 and 2015, the researchers analyzed the complications and survival outcomes of patients who underwent liver resection for HCC. In one group, 695 patients had neither portal hypertension nor multiple tumors, whereas a second group of 197 patients had both.

Compared with the first group, patients with portal hypertension and multiple tumors had worse Child-Pugh scores (P < .001), worse outcomes on the indocyanine green retention test (P < .001), more often had hepatitis C (P < .001), and had significantly higher serum alpha-fetoprotein levels (P < .001). However, patients in the first group had significantly larger tumors (median, 3.1 vs. 2.4 cm; P < .001).

Patients with portal hypertension and multiple tumors had more postoperative complications than those in the first group (46.7% vs. 35.5%; P = .004) and significantly longer postoperative length of hospital stay (median, 13 vs. 12 days; P < .001). However, in-hospital mortality rates did not differ significantly between the two groups.

After a median follow-up of 3.4 years (range, 0.2-14.5 years), 527 patients experienced HCC recurrence. Median overall (8.5 years; 95% CI, 6.6-9) and recurrence-free survival periods (2.4 years; 95% CI, 2.2-2.7) were significantly longer in the first group compared with the median overall (5.6 years; 95% CI, 4.8-6.7) and recurrence-free survival periods (1.9 years; 95% CI, 1.6-2.1) in the second group.

After multivariate analysis, the researchers found that HCV (HR = 1.29; 95% CI, 1.02-1.65), multiple tumors (HR = 1.42; 95% CI, 1.01-1.98) and vascular invasion (HR = 1.66; 95% CI, 1.31-2.1) were independent factors for overall survival after liver resection for HCC. In the second group, preoperative Child-Pugh classification was an independent factor for survival (HR = 1.51; 95% CI, 1.01-2.27).

“Despite the safety of surgical procedure, recurrence rate of HCC in patients with portal hypertension and/or multiple tumors were significantly high,” the researchers wrote. “Therefore, an ideal treatment for such patients meeting the Milan criteria is liver transplantation because this procedure can replace the precancerous damaged liver. However, graft shortages are severe problem worldwide, and liver resection should be one of the choices for patients with portal hypertension and/or multiple tumors.” – by Talitha Bennett

Disclosure: Healio.com/Hepatology was unable to determine relevant financial disclosures at time of publication.