Impact of severe oesophagogastric varices on liver resection for hepatocellular carcinoma in cirrhotic patients

World J Surg. 2015 Feb;39(2):461-8. doi: 10.1007/s00268-014-2811-9.

Abstract

Background: The aim of the present study was to clarify both short-term and long-term results of patients with concomitant hepatocellular carcinoma (HCC) and high-risk oesophagogastric varices (OGV).

Methods: This retrospective study identified 927 cirrhotic patients who underwent curative resection of HCC between 1995 and 2012 in single institution. Patients were separated into 3 groups (A, B, and C) according to general rules for recording endoscopic findings of oesophagogastric varices proposed in Japan in 1991. Groups A, B, and C consisted of patients without OGV (F0), patients with mild to moderate OGV (F1 to F2), and patients with high-risk OGV (F3 and/or red color sign), respectively. All patients in group C underwent prophylactic endoscopic variceal ligation/sclerotherapy. Post-operative complications, mortality, overall survival, and disease-free survival were compared among 3 groups.

Results: No patient had post-operative variceal bleeding. Complication rates of Clavien-Dindo grade II to V in three groups were 13.6, 14.0, and 6.9 %, respectively (P > 0.05). Operative mortality, 5-year overall survival rate, and disease-free survival rate among the 3 groups were not significantly different (P > 0.05).

Conclusions: Prophylactic endoscopic variceal ligation/sclerotherapy effectively prevented from post-operative variceal bleeding in patients with high-risk OGV. Operative mortality, major morbidity, and survival of patients with high-risk OGV were similar to those of patients without OGV or those with mild OGV. Liver resection remains a feasible choice for cirrhotic patients with concomitant HCC and high-risk OGV.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / complications
  • Carcinoma, Hepatocellular / surgery*
  • Disease-Free Survival
  • Esophageal and Gastric Varices / complications*
  • Esophageal and Gastric Varices / therapy*
  • Female
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / prevention & control*
  • Hepatectomy / adverse effects*
  • Hepatectomy / mortality
  • Humans
  • Ligation
  • Liver Cirrhosis / complications
  • Liver Neoplasms / complications
  • Liver Neoplasms / surgery*
  • Male
  • Middle Aged
  • Postoperative Hemorrhage / etiology
  • Postoperative Hemorrhage / prevention & control*
  • Postoperative Period
  • Retrospective Studies
  • Sclerotherapy*
  • Severity of Illness Index
  • Survival Rate
  • Young Adult