• Daniel Aliseda, Gabriel Zozaya, Pablo Martí-Cruchaga, Ignacio Herrero, Mercedes Iñarrairaegui, Josepmaría Argemí, Antonio Martínez De La Cuesta, Nuria Blanco, Lucas Sabatella, Bruno Sangro, and Fernando Rotellar.
• HPB and Liver Transplant Unit Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
• Ann. Surg. 2024 Jul 1; 280 (1): 465546-55.

ObjectiveExamine portal hypertension (PHT) impact on postoperative and survival outcomes in hepatocellular carcinoma (HCC) patients after liver resection (LR), specifically exploring distinctions between indirect signs and invasive measurements of PHT.BackgroundPHT has historically discouraged LR in individuals with HCC due to the elevated risk of morbidity, including liver decompensation (LD).MethodsA 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 overall survival 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).ResultsNine studies involving 1124 patients were analyzed. Indirect signs of PHT were not significantly associated with higher mortality, overall complications, PHLF or LD. However, LR in patients with hepatic venous pressure gradient (HVPG) ≥10 mm Hg significantly increased the risk of overall complications, PHLF, and LD. Despite elevated risks, the procedure resulted in a 5-year overall survival 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 minimally invasive LR.ConclusionsLR in the presence of indirect signs of PHT poses no increased risk of complications. Yet, in HVPG ≥10 mm Hg patients, LR increases overall morbidity and liver-related complications risk. Transjugular HVPG assessment is crucial for LR decisions. Minimally invasive approach seems to be vital for favorable outcomes, especially in HVPG ≥10 mm Hg patients.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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