Dynamic changes of portal vein pressure gradient under different degrees of liver cirrhosis and resection volume in the first week post hepatectomy

Xiang, Lan; Zhang, Hua; Li, Hongyu; Chen, Kefei; Liu, Fei; Yue, Wei; Li, Bo

doi:10.1111/hepr.13197

Cited by 2 publications

(4 citation statements)

References 25 publications

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“…Notably, a gradual decrease in the portal vein pressure gradient was observed during the follow-up period in most patients in concordance with liver regeneration and volume increase. 26 As shown in a recent study, the percentage of patients who underwent hepatic resection for liver tumors accompanied by postoperative splenomegaly was only 16.4% at 3 years after hepatectomy, although more than half of the patients still had incomplete liver restoration. 27 These results suggest that the portal vein pressure of most patients gradually recovers to the preoperative level, accompanied by liver regeneration and remodeling in the late postoperative period.…”

Section: Variablesmentioning

confidence: 89%

“…These structural changes would contribute to arterial hypoperfusion and pathological increases in intrahepatic vascular resistance, further increasing portal pressure 7,28 . Scarring in the cirrhotic liver leads to a reduction in elasticity and an increase in stiffness, which further contributes to an increased portal vein pressure gradient following liver resection 26 . Therefore, more attention should be paid to the possibility of PHPH in high‐risk patients with HBV infection, cirrhosis, or elevated ALT levels, and the use of drugs to decrease portal pressure should be considered.…”

Section: Discussionmentioning

confidence: 99%

“…7,28 Scarring in the cirrhotic liver leads to a reduction in elasticity and an increase in stiffness, which further contributes to an increased portal vein pressure gradient following liver resection. 26 Therefore, more attention should be paid to the possibility of PHPH in high-risk patients with HBV infection, cirrhosis, or elevated ALT levels, and the use of drugs to decrease portal pressure should be considered. From the perspective of surgery, preserving as much nontumorous liver tissue as possible while completely removing the tumor may help reduce the occurrence of PHPH and improve long-term prognosis.…”

Section: Variablesmentioning

confidence: 99%

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Role of post‐hepatectomy portal hypertension in predicting the outcome of hepatocellular carcinoma after curative resection

Lin,

Chen,

Shi

et al. 2024

Portal Hypertension & Cirrhosis

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AimsPortal venous pressure frequently increases after a major hepatectomy. We aimed to assess the outcomes of patients with hepatocellular carcinoma (HCC) with different post‐hepatectomy portal pressure statuses and the predictive factors correlated with prognosis and post‐hepatectomy portal hypertension (PHPH).MethodsData from consecutive patients who underwent curative‐intent hepatectomy for HCC at the Eastern Hepatobiliary Surgery Hospital and Mengchao Hepatobiliary Hospital of Fujian Medical University between January 2008 and December 2016 were retrospectively analyzed. Patients were followed up until March 1, 2022. PHPH was defined as new‐onset portal hypertension (PH) in patients without preoperative PH within 1 month of hepatectomy. Patients were classified into two groups according to the presence or absence of PHPH: non‐PH and PHPH. The clinicopathological characteristics were compared between the two groups. Univariate and multivariate analyses were used to identify independent risk factors for early and late recurrence of HCC, overall survival (OS), and PHPH.ResultsDisease‐free survival rates were significantly higher in the non‐PH group (n = 1068) than those in the PHPH group (n = 423) (62.0%, 39.0%, and 31.0% vs. 46.2%, 24.5%, and 19.3% at 1, 3, and 5 years, respectively; all p < 0.001). The 1‐, 3‐, and 5‐year OS rates were 91.0%, 66.4%, and 51.4% in the non‐PH group and 80.0%, 48.9%, and 32.6% in the PHPH group, respectively (all p < 0.001). Multivariate analysis revealed that PHPH was independently associated with early recurrence of HCC and poor OS (hazard ratio [HR] 1.476, 95% confidence interval [CI] 1.279–1.704, p < 0.001 and HR 1.601, 95% CI 1.383–1.853, p < 0.001, respectively). Furthermore, hepatitis B virus infection, cirrhosis, preoperative alanine aminotransferase > 40 U/L, and major hepatectomy were identified as independent risk factors for PHPH.ConclusionsPHPH was associated with early recurrence of HCC and poor OS but not with late recurrence. Therefore, PHPH may be an attractive target for therapeutic interventions and follow‐up surveillance to improve prognosis.

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Section: Variablesmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Variablesmentioning

confidence: 99%

See 1 more Smart Citation

Role of post‐hepatectomy portal hypertension in predicting the outcome of hepatocellular carcinoma after curative resection

Lin,

Chen,

Shi

et al. 2024

Portal Hypertension & Cirrhosis

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“…In the study reported by Lan et al, PVP and CVP were measured every day for a week after hepatectomy through portal and central vein catheterization [30]. It was found that PVPG was affected by extent of resection only in patients with moderate and severe cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Increase of Portal Vein Pressure Gradient After Hepatectomy Predicts Post-operative Liver Dysfunction

Xiao

Zhu

et al. 2021

Surg Innov

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Background. Post-hepatectomy liver failure (PHLF) is an important cause of mortality and morbidity. Whether Child–Pugh A patients with varying degrees of cirrhosis are good candidates for hepatectomy is disputed. The purpose of this study was to analyze the impact of portal venous pressure gradient (PVPG) variation during surgery on PHLF. Methods. PVPG, the pressure gradient between the portal vein and central vein, was measured in consecutive patients before and after liver resection. The optimal cutoff of PVPG to predict PHLF was determined by receiver operating characteristic curve analysis. Risk factors for PHLF were subjected to univariate and multivariable analysis. Results. Sixty Child–Pugh A patients were recruited. The mean PVPG was increased from 5.17 ± 4.78 mm of mercury (mmHg) to 6.37 ± 4.44 mmHg after liver resection. The optimal cutoff value of PVPG increments to predict PHLF was 1.5 mmHg. Multivariable analysis showed prothrombin time (PT), post-hepatectomy PVPG increments of 1.5 mmHg or greater, and resected liver segments of 3 or more to be independent predictors of PHLF. Conclusions. Acute PVPG increase after hepatectomy is associated with a higher risk of PHLF in Child–Pugh A patients.

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Dynamic changes of portal vein pressure gradient under different degrees of liver cirrhosis and resection volume in the first week post hepatectomy

Cited by 2 publications

References 25 publications

Role of post‐hepatectomy portal hypertension in predicting the outcome of hepatocellular carcinoma after curative resection

Role of post‐hepatectomy portal hypertension in predicting the outcome of hepatocellular carcinoma after curative resection

Increase of Portal Vein Pressure Gradient After Hepatectomy Predicts Post-operative Liver Dysfunction

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