Portal Pressure Impact on Clinical Outcome after Major Hepatectomy: A Systematic Review and Meta-Analysis

Abstract

Aim of the study: To systematically review the evidence regarding the association between portal venous pressure (PVP) after hepatectomy and posthepatectomy liver failure (PLHF) or other postsurgical outcomes. Materials and methods: We searched PubMed, Scopus and Web of Science for studies assessing post-hepatectomy PVP (or its variation) and reporting its association with PHLF or other postsurgical outcomes. We performed a random-effects meta-analysis for the association between development of PHLF and post-hepatectomy PVP and its variation. Heterogeneity was assessed using Q-Cochran test and I2 statistic. Quality assessment was performed considering ROBINS-1 Cochrane tool. Results: Four studies, assessing 439 patients, met the eligibility criteria and were included in this systematic review. The meta-analyses, including 3 studies, demonstrated that patients developing PHLF did not have a significantly higher post-hepatectomy PVP when compared to the remainder (1.98; 95%CI=-1.44-5.39; p=0.256; I2=2%), but had a significantly higher PVP variation (increase) during hepatectomy (1.65; 95%CI=1.15-2.15; p<0.001; I2=0%). The quality of the studies allowed to consider the robustness of the conclusions as “median”. Conclusions: An increased PVP variation following hepatectomy associates with a higher risk of PHLF, but the same was not observed for the absolute value of post-hepatectomy PVP.