Portal pressure and somatostatin: variations and effects after major hepatectomy

Abstract

Background: Major hepatectomy (MH) can lead to an increasing portal pressure(PP) and to lesions of the hepatic parenchyma. Somatostatin was efficient in experimental studies as a reversible portal inflow modulator (PIM) [1]. The aim of this study was to assess the effect of a high PP in the course of MH and to evaluate the impact of somatostatin in PP modulation and in liver function preservation. Methods: Between January 2015 and December 2016, 52 patients underwent MH. Among them,30 were included in a prospective protocol with an intraoperative measurement of PP. Somatostatin was used in 10 patients with a post-hepatectomy PP (PHPP) above 20 mmHg. Liver laboratory tests, postoperative morbidity and mortality were evaluated. The MD Anderson postoperative liver failure definition was used. Results: In this study, 30 patients were enrolled. Patients were divided into two groups according to PHPP: Group A(PHPP>20 mmHg)and group B(PHPP<20 mmHg)with respectively 13 and 17 patients. POLF occurred only in group A accounting for 4 cases(30%) with 4 deaths(p=0.05). In group A, 10 patients received somatostatin. The mean decrease of PP(ΔPP) was 3.3. In 4 patients, ΔPP was less than 3 mmHg; among them two cases of POLF occurred. In the opposite case, with a ΔPP above 3 mmHg, no cases of POLF happened (p= 0.05). Conclusion: Elevated PHPP is associated with a worse outcome after MH with a higher risk of POLF. Somatostatin is efficient as a reversible PIM and can thus reduce the risk of POLF especially in patients h a ΔPP above 3 mmHg.