Research ArticleHepatic venous pressure gradient in the preoperative assessment of patients with resectable hepatocellular carcinoma

Backgrounds & AimsTo assess the relationship existing between hepatic venous pressure gradient (HVPG) and the occurrence of post-hepatectomy liver failure (PHLF) grade B/C after resection of hepatocellular carcinoma (HCC) and persistent worsening of liver function.MethodsData from 70 consecutive prospectively enrolled HCC patients undergoing resection were collected and analysed. PHLF grade B/C was defined by the International Study Group of Liver Surgery recommendations. The appearance of unresolved decompensation was also analysed.ResultsPostoperative and 90-day mortality were null. The median HVPG value was 9 mmHg (range: 4-18) and the median Model for End-stage Liver Disease (MELD) score was 8 (range: 6-14); 34 patients had an HVPG ⩾10 mmHg (48.6%). Forty-nine patients had an uneventful (Grade A) postoperative course, including 17 with an HVPG ⩾10 mmHg (24.2% of 70 patients). Grade B complications occurred in 20 patients (3 with an HVPG <10 mmHg and 17 with an HVPG ⩾10 mmHg; p <0.001); only one grade C complication occurred in a patient with an HVPG <10 mmHg, subsequently successfully undergoing liver transplantation. Median MELD score returned to preoperative values after a transient postoperative increase, regardless of the HVPG values; after three months, it returned to the preoperative of 8 in patients with an HVPG <10 mmHg and of 9 in patients with an HVPG ⩾10 mmHg (p = 0.077 and 0.076 at paired test, respectively).ConclusionsThe hepatic venous pressure gradient can be used before surgery to stratify the risk of PHLF but the proposed cut-off of 10 mmHg excludes approximately one-quarter of the patients who would benefit from surgery without short to mid-term postoperative sequelae.

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