Portal Venous Pressure Variation during Hepatectomy: A Prospective Study

Detalhes bibliográficos
Autor(a) principal: Carrapita, Jorge Gomes
Data de Publicação: 2019
Outros Autores: Rocha, Clara, Donato, Henrique, Costa, Alexandre, Abrantes, Ana Margarida, Santos, Jorge Nunes, Botelho, Maria Filomena, Tralhão, José Guilherme, Barbosa, Jorge Maciel
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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spelling 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
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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
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https://doi.org/10.20344/amp.10892
dc.language.iso.fl_str_mv eng
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0870-399X
31292022
1646-0758
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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)
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collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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