Transient elastography is an effective method of predicting posthepatectomy outcomes in patients undergoing hepatectomy for hepatocellular carcinoma

Abstract

Background: Invasive measurement of hepatic venous pressure gradient(HVPG) is needed to diagnose clinical significant portal hypertension(CSPH) preoperatively in hepatectomy. Effectiveness of liver stiffness measurement(LSM) in predicting persistent posthepatectomy hepatic decompensation(PHD), an important complication of CSPH was investigated. Methods: Consecutive patients with resectable hepatocellular carcinoma(HCC)were recruited prospectively. LSM of non-tumoral liver was measured using FibroScan® preoperatively and HVPG was measured peroperatively. HVPG≥10mmHg was defined as CSPH. PHD was defined as the presence of atleast one of the following unresolved ascites, jaundice, and/or encephalopathy beyond 3 months following hepatectomy. Results: Study included 106 hepatectomies for HCC in Child-Pugh A/B patients(84 men and 22 women; median age:67.5years) including right hepatectomy(20.8%), central hepatectomy(1.9%), left hepatectomy(8.5%), bisegmentectomy(14.1%), unisegmentectomy(28.3%) and partial hepatectomy(26.4%). Nine patients(8.5%) developed PHD. Bootstrapped multivariate logistic regression identified LSM(P=0.001) as the only preoperative predictor of PHD. Area under ROC curve for LSM and HVPG was 0.807(95%CI=0.506-0.907) and 0.712(95%CI=0.646-0.917) respectively. LSM≥12kPa had 85.7% sensitivity and 66.7% specificity. HVPG≥10mmHg had 28.6% sensitivity and 96.3% specificity. Conclusion: In patients undergoing hepatectomy for HCC, LSM is an effective test to predict PHD pre-operatively when compared to HVPG.