Hepatocellular carcinoma in cirrhotic patients with portal hypertension: Is liver resection always contraindicated?

Abstract Objective: To determine whether routine preoperative hepatic venous pressure gradient measurements are necessary in child’s-A cirrhotic patients undergoing liver resection for hepatocellular carcinoma, and to assess immediate post-operative liver dysfunction and 30-day mortality in such cases. Methods: The 3-year audit was done at Shuakat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data from January 1, 2015, to December 31, 2017, of all Child’s class “A” patients with hepatocellular carcinoma without any clinical signs of portal hypertension who had preoperative hepatic venous pressure gradient measurements done were. A proforma was used to collect the required data from patient files. Data was analysed using SPSS 21. Results: Of the 20 patients, 11(55%) were males. The overall mean age was 60.6+7.4 years. Only 2(10%) patients had raised hepatic venous pressure gradient. Of the total, 14(70%) patients underwent surgery. Mean duration of surgery was 222+82.5 minutes and mean hospital stay was 6.8+3.2 days. None of the patients had deranged prothrombin-time or bilirubin on postoperative day 5. Conclusion: The incidence of subclinical portal hypertension was very low. Hepatic venous pressure gradient measurement can be avoided in early stage hepatocellular carcinoma for child’s A cirrhotic patients undergoing liver resection. Key Words: Portal hypertension, Hepatic venous pressure gradient, Continuous...

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Laparoscopic versus Open Liver Resection: Differences in Intraoperative and Early Postoperative Outcome among Cirrhotic Patients with Hepatocellular Carcinoma—A Retrospective Observational Study

HPB Surgery ◽

10.1155/2014/871251 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 14

Author(s):

Antonio Siniscalchi ◽

Giorgio Ercolani ◽

Giulia Tarozzi ◽

Lorenzo Gamberini ◽

Lucia Cipolat ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Liver Function ◽

Hospital Stay ◽

Perioperative Complications ◽

Laparoscopic Approach ◽

Postoperative Outcome ◽

Laparoscopic Technique ◽

Surgical Trauma ◽

Cirrhotic Patients

Introduction. Laparoscopic liver resection is considered risky in cirrhotic patients, even if minor surgical trauma of laparoscopy could be useful to prevent deterioration of a compromised liver function. This study aimed to identify the differences in terms of perioperative complications and early outcome in cirrhotic patients undergoing minor hepatic resection for hepatocellular carcinoma with open or laparoscopic technique. Methods. In this retrospective study, 156 cirrhotic patients undergoing liver resection for hepatocellular carcinoma were divided into two groups according to type of surgical approach: laparoscopy (LS group: 23 patients) or laparotomy (LT group: 133 patients). Perioperative data, mortality, and length of hospital stay were recorded. Results. Groups were matched for type of resection, median number of nodules, and median diameter of largest lesions. Groups were also homogeneous for preoperative liver and renal function tests. Intraoperative haemoglobin decrease and transfusions of red blood cells and fresh frozen plasma were significantly lower in LS group. MELD score lasted stable after laparoscopic resection, while it increased in laparotomic group. Postoperative liver and renal failure and mortality were all lower in LS group. Conclusions. Lower morbidity and mortality, maintenance of liver function, and shorter hospital stay suggest the safety and benefit of laparoscopic approach.

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Hepatic resection for hepatocellular carcinoma in cirrhotic patients with portal hypertension

Surgical Practice ◽

10.1111/1744-1633.12215 ◽

2016 ◽

Vol 20 (4) ◽

pp. 149-156 ◽

Cited By ~ 2

Author(s):

Hazem M. Zakaria ◽

Emad H. Gad ◽

Ali Nada ◽

Anwar A. Abdelaleem ◽

Doha Maher ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Portal Hypertension ◽

Hepatic Resection ◽

Cirrhotic Patients

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Radiofrequency-Assisted liver resection in cirrhotic patients with hepatocellular carcinoma

Journal of Surgical Oncology ◽

10.1002/jso.21129 ◽

2008 ◽

Vol 98 (6) ◽

pp. 407-410 ◽

Cited By ~ 16

Author(s):

Giuseppe Curro ◽

Long Jiao ◽

Claudio Scisca ◽

Umberto Baccarani ◽

Massimo Mucciardi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Cirrhotic Patients

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Frequency of High MELD Score in Cirrhotic Patients undergoing Liver Resection due to Hepatocellular Carcinoma

10.53350/pjmhs211592841 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2841-2843

Author(s):

Muhammad Omer Farooq ◽

Niaz Ahmed ◽

Hassan Nadeem ◽

Kashif Rafi ◽

Sadia Jabbar ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Cross Sectional Study ◽

Meld Score ◽

Cross Sectional ◽

Female Ratio ◽

Score Study ◽

Insignificant Difference ◽

Cirrhotic Patients ◽

Male To Female

Objective: To determine the frequency of high MELD score in cirrhotic patients undergoing liver resection due to hepatocellular carcinoma also compare the frequency of mortality in patients with high or low MELD score. Study Design: Cross sectional study Place and Duration: Department of Gastroenterology, Shaikh Zayed Hospital, Lahore. Duration: 6months i.e. 23 12-2017 to 22-06-2018. Methodology: 75 patients were enrolled. Then blood sample was obtained. Reports assessed and MELD score calculated. Scores were labeled as high or low. Patients underwent liver resection according to BCLC. The mortality was noted. All the collected data was entered and analyzed on SPSS version 22. Results: In this study out of total 75 cases 60 were males and 15 females. The mean age of patients was 39.44±9.76 years, male to female ratio was 4:1. Low MELD class was noted in 45 (60%) cases and high MELD class noted in 30(40%) cases. Mortality occurred in 27(36%) cases. Insignificant difference found between the MELD class with mortality. Conclusion: High MELD score was seen in 40% cirrhotic patients undergoing liver resection due to HCC. Post HCC resection, mortality occurred in 36% patients within three months of surgery. No significant association was found between the mortality and MELD score. Keywords: MELD, Hepatocellular Carcinoma, Mortality, Cirrhosis

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Liver resection of hepatocellular carcinoma in patients with portal hypertension and multiple tumors

Hepatology Research ◽

10.1111/hepr.13047 ◽

2018 ◽

Vol 48 (6) ◽

pp. 433-441 ◽

Cited By ~ 8

Author(s):

Takao Ohkubo ◽

Yutaka Midorikawa ◽

Hisashi Nakayama ◽

Masamichi Moriguchi ◽

Osamu Aramaki ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Portal Hypertension ◽

Liver Resection ◽

Multiple Tumors

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Assessment of Safety and Applicability of Laparoscopic vs Open Non Anatomical Resection of Hepatocellular Carcinoma in Cirrhotic Patients

QJM ◽

10.1093/qjmed/hcab097.007 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohammed Mahfouz Mohammed ◽

Hany Saeed Abdel Basset ◽

Mohammed Abd Almegeed Elsayed ◽

Ahmed Abdel Basset Hegazi

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Laparoscopic Liver Resection ◽

Operative Time ◽

Short Term ◽

Open Liver Resection ◽

Resection Group ◽

Significant Difference ◽

Cirrhotic Patients ◽

The Mean

Abstract Background Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Liver surgery was one of the last frontiers reached by minimally invasive surgery. Surgical technique and equipment evolved to overcome technical limitations, making laparoscopic liver resections (LLR) safe and feasible. Surgeons developed skills in a stepwise approach, beginning with low complexity operations for benign diseases and reaching high-complexity surgeries for malignant cases and living donor organ harvesting. Objective s: The aim of the study is to compare short term results of laparoscopic versus open hepatectomy regarding to intra operative details and post-operative management and complications for achieving a safe hepatic resection for treatment of HCC in cirrhotic patients. Patients and Methods In this prospective study, a comparison between laparoscopic resection and open resection was done to compare short-term results between laparoscopic and open liver resection. This study was conducted on 30 patients with hepatocellular carcinoma. 15 patients (50%) were treated by laparoscopic liver resection (Group A) while the other 15 patients (50%) were treated by open liver resection (Group B). Results Regarding the demographic data, the presence of past history of medical condition and the preoperative laboratory results, no statistical significance was found. The mean operative time has statistically significant difference between the 2 groups, with decreased operative time in the laparoscopic group (P < 0.001). The mean blood loss has no statistically significant difference relations between the 2 groups, (P = 0.866) with conversion rate of (13.3%) happened in two cases. Conclusion Laparoscopic liver resection is a safe and feasible treatment option for HCC in cirrhotic patient needing minor resection at laparoscopic segments (II, III, IVa,V,VI). Laparoscopic liver resection for HCC has superior short- term and comparable oncological outcomes to open liver resection. LLR should be performed for carefully selected patients and by an expert surgical team.

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