Surgical Resection for Hepatocellular Carcinoma with Concomitant Esophageal Varices

Abstract

These results suggest that HCC patients with EV and ICGR15 ≤17 % may be suitable for surgery, but patients with preoperative endoscopic blue color EV and red color sign need to be managed appropriately.

The impact of esophagogastric varices on the prognosis of patients with hepatocellular carcinoma

“…In this study, compared to the HCC patients without EGV, those patients with EGV had lower platelet counts; lower serum albumin levels; higher ALT, AST, and bilirubin levels; and higher Child-Pugh scores, indicating that they had poorer liver functional reserves, more active hepatic necro-inflammation, and even advanced fibrosis. These findings are consistent with the previous reports 18 20 21 29 . As these factors are critical in determining the prognosis of the patients with HCC, CSPH and EGV have been incorporated into the BCLC staging system and are widely applied as important references when selecting the treatment modalities in daily practice 24 30 .…”

“…It is based on the negative impact of PHT and CSPH on the postoperative prognoses, including post-hepatectomy liver failure and long-term survival, demonstrated by several prospective studies and meta-analyses 9 29 32 33 . However, several recent studies demonstrate that CSPH is not a contraindication of resection for HCC 20 21 34 35 36 . Harada disclosed that HCC patients with EV could achieve similar long-term outcomes as those patients without EV if an indocyanine green retention test at 15 minutes (ICGR15) ≤17% 20 .…”

“…However, several recent studies demonstrate that CSPH is not a contraindication of resection for HCC 20 21 34 35 36 . Harada disclosed that HCC patients with EV could achieve similar long-term outcomes as those patients without EV if an indocyanine green retention test at 15 minutes (ICGR15) ≤17% 20 . Another recent study conducted by Cucchetti further showed that, although measuring the HVPG could be used for predicting the risk of hepatic decompensation after resection surgery for HCC, the current recommended threshold of 10 mmHg in determining CSPH might too low, which in turn excluded around one-quarter of the patients suitable for resection surgery 29 .…”

“…Several previous studies further demonstrate that more than 50% of patients have concomitant EGV when HCC is diagnosed 18 19 . However, whether or not EGV are associated with the prognoses of patients with HCC is not yet fully elucidated 18 20 21 . We deduced that HCC patients with EGV might have relatively poor liver functional reserves, leading to poor outcomes.…”

Selection of patients with esophageal varices for liver resection of hepatocellular carcinoma

“…Consistent with the BCLC staging system, previous reports demonstrated that patients with portal hypertension were not candidates for liver resection due to concomitant cirrhosis and thrombocytopenia, especially in Western countries (4,5). On the other hand, recent studies have reported that the presence of EV (6)(7)(8) or portal hypertension (9-12) is not an absolute contraindication for liver resection because the surgical outcomes of patients with HCC who underwent appropriate management for EV were acceptable. Thus, the outcomes of surgical resection for HCC in patients with portal hypertension are not completely understood.…”