Portal Venous Pressure Variation during Hepatectomy: A Prospective Study
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10316/106779 https://doi.org/10.20344/amp.10892 |
Resumo: | Introduction: Excessive portal venous pressure in the liver remnant is an independent factor in the occurrence of posthepatectomy liver failure and small-for-size syndrome. The baseline portal pressure prior to hepatectomy was not considered previously. The aim of this study is to assess the impact of portal pressure change during hepatectomy on the patient outcome. Material and Methods: Prospective observational study including 30 patients subjected to intraoperative measurement of portal pressure before and after hepatectomy. This variation was related to the patient outcome. Control group evaluation was assessed. Patient, disease and procedure features were considered. The optimal cut-off of portal pressure variation was determined. Linear regression or logistic regression was applied to identify predictors of the outcome. Results: The univariate analysis showed that portal pressure increase after hepatectomy was associated with coagulation impairment in the first 30 postoperative days (p < 0.05), and with the occurrence of major complications (p = 0.01), namely hepatic failure (p = 0.041). The multivariate analysis showed that portal venous pressure increase ≥ 2 mmHg is an independent factor for worse outcomes. Discussion: As in previous studies, this study concludes that, after hepatectomy, in addition to the functional liver remnant, other factors are responsible for deterioration of liver function and patient outcome, such as the portal pressure increase and the exposure to chemotherapy prior to hepatectomy. This work may influence the definition of future indications for portal influx modulation. Conclusion: Patient outcomes are influenced by the portal venous pressure increase: an increment ≥ 2 mmHg after hepatectomy seems to increase the risk of major complications. |
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Portal Venous Pressure Variation during Hepatectomy: A Prospective StudyVariação da Pressão Venosa Portal durante Hepatectomia: Um Estudo ProspectivoHepatectomyPortal PressurePortal VeinHepatectomiaPressão PortalVeia PortaIntroduction: Excessive portal venous pressure in the liver remnant is an independent factor in the occurrence of posthepatectomy liver failure and small-for-size syndrome. The baseline portal pressure prior to hepatectomy was not considered previously. The aim of this study is to assess the impact of portal pressure change during hepatectomy on the patient outcome. Material and Methods: Prospective observational study including 30 patients subjected to intraoperative measurement of portal pressure before and after hepatectomy. This variation was related to the patient outcome. Control group evaluation was assessed. Patient, disease and procedure features were considered. The optimal cut-off of portal pressure variation was determined. Linear regression or logistic regression was applied to identify predictors of the outcome. Results: The univariate analysis showed that portal pressure increase after hepatectomy was associated with coagulation impairment in the first 30 postoperative days (p < 0.05), and with the occurrence of major complications (p = 0.01), namely hepatic failure (p = 0.041). The multivariate analysis showed that portal venous pressure increase ≥ 2 mmHg is an independent factor for worse outcomes. Discussion: As in previous studies, this study concludes that, after hepatectomy, in addition to the functional liver remnant, other factors are responsible for deterioration of liver function and patient outcome, such as the portal pressure increase and the exposure to chemotherapy prior to hepatectomy. This work may influence the definition of future indications for portal influx modulation. Conclusion: Patient outcomes are influenced by the portal venous pressure increase: an increment ≥ 2 mmHg after hepatectomy seems to increase the risk of major complications.Introdução: O aumento da pressão venosa portal para o remanescente hepático é um fator independente para falência hepática após hepatectomia e síndrome small-for-size. Estudos anteriores não consideram o valor de pressão portal prévio à hepatectomia. O objetivo deste estudo é analisar o impacto da variação da pressão portal durante a hepatectomia na evolução clínica pós-operatória. Material e Métodos: Estudo observacional prospetivo, incluindo 30 doentes submetidos a medição intraoperatória da pressão portal antes e após hepatectomia, relacionando esta variação com a evolução clínica pós-operatória. Avaliação similar foi efetuada num grupo de controlo. Fatores relacionados com o doente, doença e procedimento foram considerados. Determinou-se o valor ideal de variação da pressão portal. Regressão linear ou logística foram aplicadas para identificar fatores preditores de evolução clínica. Resultados: A análise univariada mostrou que um aumento de pressão portal após hepatectomia associa-se a deterioração da coagulação nos primeiros 30 dias após hepatectomia (p < 0,05), a complicações major (p = 0,01) como a falência hepática após hepatectomia (p = 0,041). A análise multivariada mostrou que um aumento de pressão portal ≥ 2 mmHg é um fator independente para a evolução clínica pós-operatória desfavorável. Discussão: Após hepatectomia, para além do remanescente hepático funcional, outros fatores são responsáveis pela deterioração da função hepática e pela morbimortalidade, como o aumento da pressão portal e a exposição prévia a quimioterapia. Este trabalho contribui para a definição futura das indicações para modulação do influxo portal. Conclusão: Um aumento de pressão portal ≥ 2 mmHg após hepatectomia parece agravar o risco de complicações major.Ordem dos Médicos2019-06-28info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://hdl.handle.net/10316/106779http://hdl.handle.net/10316/106779https://doi.org/10.20344/amp.10892eng1646-07580870-399X312920221646-0758Carrapita, Jorge GomesRocha, ClaraDonato, HenriqueCosta, AlexandreAbrantes, Ana MargaridaSantos, Jorge NunesBotelho, Maria FilomenaTralhão, José GuilhermeBarbosa, Jorge Macielinfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-04-21T10:35:27Zoai:estudogeral.uc.pt:10316/106779Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T21:23:10.967057Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Portal Venous Pressure Variation during Hepatectomy: A Prospective Study Variação da Pressão Venosa Portal durante Hepatectomia: Um Estudo Prospectivo |
title |
Portal Venous Pressure Variation during Hepatectomy: A Prospective Study |
spellingShingle |
Portal Venous Pressure Variation during Hepatectomy: A Prospective Study Carrapita, Jorge Gomes Hepatectomy Portal Pressure Portal Vein Hepatectomia Pressão Portal Veia Porta |
title_short |
Portal Venous Pressure Variation during Hepatectomy: A Prospective Study |
title_full |
Portal Venous Pressure Variation during Hepatectomy: A Prospective Study |
title_fullStr |
Portal Venous Pressure Variation during Hepatectomy: A Prospective Study |
title_full_unstemmed |
Portal Venous Pressure Variation during Hepatectomy: A Prospective Study |
title_sort |
Portal Venous Pressure Variation during Hepatectomy: A Prospective Study |
author |
Carrapita, Jorge Gomes |
author_facet |
Carrapita, Jorge Gomes Rocha, Clara Donato, Henrique Costa, Alexandre Abrantes, Ana Margarida Santos, Jorge Nunes Botelho, Maria Filomena Tralhão, José Guilherme Barbosa, Jorge Maciel |
author_role |
author |
author2 |
Rocha, Clara Donato, Henrique Costa, Alexandre Abrantes, Ana Margarida Santos, Jorge Nunes Botelho, Maria Filomena Tralhão, José Guilherme Barbosa, Jorge Maciel |
author2_role |
author author author author author author author author |
dc.contributor.author.fl_str_mv |
Carrapita, Jorge Gomes Rocha, Clara Donato, Henrique Costa, Alexandre Abrantes, Ana Margarida Santos, Jorge Nunes Botelho, Maria Filomena Tralhão, José Guilherme Barbosa, Jorge Maciel |
dc.subject.por.fl_str_mv |
Hepatectomy Portal Pressure Portal Vein Hepatectomia Pressão Portal Veia Porta |
topic |
Hepatectomy Portal Pressure Portal Vein Hepatectomia Pressão Portal Veia Porta |
description |
Introduction: Excessive portal venous pressure in the liver remnant is an independent factor in the occurrence of posthepatectomy liver failure and small-for-size syndrome. The baseline portal pressure prior to hepatectomy was not considered previously. The aim of this study is to assess the impact of portal pressure change during hepatectomy on the patient outcome. Material and Methods: Prospective observational study including 30 patients subjected to intraoperative measurement of portal pressure before and after hepatectomy. This variation was related to the patient outcome. Control group evaluation was assessed. Patient, disease and procedure features were considered. The optimal cut-off of portal pressure variation was determined. Linear regression or logistic regression was applied to identify predictors of the outcome. Results: The univariate analysis showed that portal pressure increase after hepatectomy was associated with coagulation impairment in the first 30 postoperative days (p < 0.05), and with the occurrence of major complications (p = 0.01), namely hepatic failure (p = 0.041). The multivariate analysis showed that portal venous pressure increase ≥ 2 mmHg is an independent factor for worse outcomes. Discussion: As in previous studies, this study concludes that, after hepatectomy, in addition to the functional liver remnant, other factors are responsible for deterioration of liver function and patient outcome, such as the portal pressure increase and the exposure to chemotherapy prior to hepatectomy. This work may influence the definition of future indications for portal influx modulation. Conclusion: Patient outcomes are influenced by the portal venous pressure increase: an increment ≥ 2 mmHg after hepatectomy seems to increase the risk of major complications. |
publishDate |
2019 |
dc.date.none.fl_str_mv |
2019-06-28 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10316/106779 http://hdl.handle.net/10316/106779 https://doi.org/10.20344/amp.10892 |
url |
http://hdl.handle.net/10316/106779 https://doi.org/10.20344/amp.10892 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
1646-0758 0870-399X 31292022 1646-0758 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
Ordem dos Médicos |
publisher.none.fl_str_mv |
Ordem dos Médicos |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
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1817549951998099456 |