A Feasibility Analysis on Hepatic Resection for Hepatocellular Carcinoma in Portal Hypertensive Cirrhotic Patients

JIANG Tao; HE Qian; ZHANG Cheng-hua; DU Zhen-shuang

doi:10.3969/j.issn.1002-3429.2015.02.036

Abstract：Objective To analyze the feasibility of curative hepatectomy for hepatocellular carcinoma ( HCC) in portal hypertensive ( PH) cirrhotics patients. Methods Clinical data of 512 liver cirrhosis and HCC cases in the hospital during Janu-ary 2009 and March 2013, were retrospectively analyzed. According to the portal venous pressure, the patients were divided into hypertension group (n=143) and non hypertension group (n=369);General data of the postoperative mortality, operation situ-ation, postoperative complications, and survival rates of the 2 group during the follow-up period were compared. Living status and factors influencing the living status and the cause of death of two groups were analyzed. Results Before operation, the pro-portion of Child-Pugh class B, serum total bilirubin >20μmol/L, albumin <35 g/L, blood transfusions were higher than those of non portal hypertension group, the proportion of tumor diameter ≥5 cm were lower than that of non venous pressure groups, and the difference was statistically significant (P<0. 05). In high pressure group, the operation time, intraoperative blood loss, postoperative hospital stay, fatality rate and complication rate after operation were lower than those of non venous pressure group, and the difference was statistically significant (P<0. 05). The survival rate during the follow-up period of hypertension group was lower than that of non hypertension group, and the difference was statistically significant (P<0. 05). It was shown that por-tal hypertension, alpha fetoprotein levels were >20μg/L, the tumor diameter was≥5 cm, liver resection was >1 hepatic seg-ment, no transcatheter hepatic arterial chemoembolization (TACE) before operation, low histologic differentiation was low, cut-ting edge was <0. 5 cm, the survival rate of the patients with multiple lesions HCC decreased significantly (P<0. 05), cox re-gression analysis showed that tumor diameter ≥5 cm, multiple lesion in HCC and no TACE before operation were independent risk factors causing death of patients with cirrhosis of liver after hepatectomy. Conclusion PH is not an independent risk factor for survival for hepatic cirrhosis related HCC patients after hepatic resection, liver resection for patients suffering from HCC with PH is feasible, and liver function protection is important after resection.