1Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd); Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS).
Whether pre-operative clinically significant portal hypertension (CSPH) has or not an impact on the outcome of surgery for hepatocellular carcinoma (HCC) in patients with compensated cirrhosis is debated. This systematic review assesses the impact of CSPH on the outcome of HCC in patients with compensated cirrhosis treated with surgery. We performed a systematic search of the MEDLINE database (articles published in full in English language from 1996 to October 2013) and related bibliography for studies reporting on the postoperative outcomes (3- and 5-year mortality and/or early clinical decompensation) of patients with HCC and compensated cirrhosis treated with surgery according to the presence or absence of CSPH. Independent extraction of articles by two authors using predefined data fields, including study quality indicators was used; pooled analyses were based on random-effects models. Eleven studies in total met our inclusion criteria (eight studies for 3- and 5-year postoperative mortality and 8 studies for postoperative clinical decompensation). Moderate heterogeneity among studies for both outcomes was observed, which disappeared after pooling studies using similar methods to assess CSPH. The presence of CSPH increased the risk of 3- and 5-year mortality vs. absence of CSPH: pooled odds ratio (OR) for 3-year mortality: 2.09; 95% confidence interval [CI], 1.52-2.88; for 5-year mortality: 2.07; 95% CI, 1.51-2.84. CSPH also increased the risk of postoperative clinical decompensation (pooled OR: 3.04; 95% CI, 2.02-4.59). Conclusions: CSPH (evaluated by any method) significantly increases the risk of 3- and 5-year mortality and of clinical decompensation after surgery for HCC.