Influence of Clinically Significant Portal Hypertension on Hepatectomy for Hepatocellular Carcinoma: a Meta-analysis

Background: Clinically significant portal hypertension (PHT) is considered as a contraindication forhepatectomy according to the guidelines of the European Association for Study of Liver and the AmericanAssociation for Study of Liver Diseases. However, this issue remains controversial. Here we performed a metaanalysisto evaluate the impact of PHT on the results of hepatectomy for hepatocellular carcinoma (HCC).
Methods: Cohort studies evaluating the impact of clinically significant PHT, defined as oesophageal varices and/or splenomegaly associated with thrombocytopenia, on the results of hepatectomy for HCC were identified usinga predefined search strategy. Summary risk ratios (RRs) and 95% confidence intervals (95% CIs) for PHT andoutcomes after hepatectomy for HCC were calculated.
Results: Seven cohort studies which including 574 caseswith PHT and 1,354 cases without PHT were considered eligible for inclusion. The meta-analysis showed that, inall patients, pooled RRs of post-operative liver failure, post-operative ascites, peri-operative blood transfusion,operative mortality, 3- and 5-year overall survival associated with PHT were 2.23 (95% CI: 1.48-3.34, P=0.0001),1.77 (95% CI: 1.19-2.64, P=0.005), 1.23 (95% CI: 1.03-1.49, P=0.03), 2.58 (95% CI: 1.12-5.96, P=0.03), 0.82 (95%CI: 0.75-0.88, P<0.00001) and 0.76 (95% CI: 0.69-0.85, P<0.00001), respectively. In subgroup analysis, similarresults were found in Child-Pugh class A patients.
Conclusion: This meta-analysis suggests that presence ofoesophageal varices and/or splenomegaly associated with thrombocytopenia is associated with higher rates ofpost-operative complications and poor long-term survival after hepatectomy for HCC.