The Impact of Portal Hypertension Assessment Method on the Outcomes of Hepatocellular Carcinoma Resection: A Meta-Analysis of Matched Cohort and Prospective studies.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
21 Dec 2023
21 Dec 2023
Historique:
medline:
21
12
2023
pubmed:
21
12
2023
entrez:
21
12
2023
Statut:
aheadofprint
Résumé
Examine PHT impact on postoperative and survival outcomes in HCC patients after LR, specifically exploring distinctions between indirect signs and invasive measurements of PHT. PHT has historically discouraged LR in individuals with HCC, due to the elevated risk of morbidity, including liver decompensation (LD). A systematic review was conducted using 3 databases to identify prospective controlled and matched cohort studies until December 28, 2022. Focus on comparing postoperative outcomes (mortality, morbidity, and liver-related complications) and OS in HCC patients with and without PHT undergoing LR. Three meta-analysis models were utilized: For aggregated data (fixed-effects inverse variance model), for patient-level survival data (one-stage frequentist meta-analysis with gamma-shared frailty Cox proportional hazards model), and for pooled data (Freeman-Tukey exact and double arcsine method). Nine studies involving 1,124 patients were analyzed. Indirect signs of PHT were not significantly associated with higher mortality, overall complications, PHLF or LD. However, LR in patients with HVPG ≥10 mmHg significantly increased the risk of overall complications, PHLF and LD. Despite elevated risks, the procedure resulted in a 5-year OS rate of 55.2%. Open LR significantly increased the risk of overall complications, PHLF and LD. Conversely, PHT did not show a significant association with worse postoperative outcomes in MILR. LR with indirect PHT signs poses no increased risk of complications. Yet, in HVPG ≥10 mmHg patients, LR increases overall morbidity and liver-related complications risk. Transjugular HVPG assessment is crucial for LR decisions. MI approach seems to be vital for favorable outcomes, especially in HVPG ≥10 mmHg patients.
Sections du résumé
OBJECTIVE
OBJECTIVE
Examine PHT impact on postoperative and survival outcomes in HCC patients after LR, specifically exploring distinctions between indirect signs and invasive measurements of PHT.
SUMMARY BACKGROUND DATA
BACKGROUND
PHT has historically discouraged LR in individuals with HCC, due to the elevated risk of morbidity, including liver decompensation (LD).
METHODS
METHODS
A systematic review was conducted using 3 databases to identify prospective controlled and matched cohort studies until December 28, 2022. Focus on comparing postoperative outcomes (mortality, morbidity, and liver-related complications) and OS in HCC patients with and without PHT undergoing LR. Three meta-analysis models were utilized: For aggregated data (fixed-effects inverse variance model), for patient-level survival data (one-stage frequentist meta-analysis with gamma-shared frailty Cox proportional hazards model), and for pooled data (Freeman-Tukey exact and double arcsine method).
RESULTS
RESULTS
Nine studies involving 1,124 patients were analyzed. Indirect signs of PHT were not significantly associated with higher mortality, overall complications, PHLF or LD. However, LR in patients with HVPG ≥10 mmHg significantly increased the risk of overall complications, PHLF and LD. Despite elevated risks, the procedure resulted in a 5-year OS rate of 55.2%. Open LR significantly increased the risk of overall complications, PHLF and LD. Conversely, PHT did not show a significant association with worse postoperative outcomes in MILR.
CONCLUSIONS
CONCLUSIONS
LR with indirect PHT signs poses no increased risk of complications. Yet, in HVPG ≥10 mmHg patients, LR increases overall morbidity and liver-related complications risk. Transjugular HVPG assessment is crucial for LR decisions. MI approach seems to be vital for favorable outcomes, especially in HVPG ≥10 mmHg patients.
Identifiants
pubmed: 38126757
doi: 10.1097/SLA.0000000000006185
pii: 00000658-990000000-00733
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Disclosures: None of the authors have any conflict of interest or financial disclosures related to this manuscript.