AIM OF THE STUDY: To evaluate the role of hepatic venous pressure gradient (HVPG) measurement in patients with resectable hepatocellular carcinoma (HCC) we describe our experience with the procedure as part of our hospital standard preoperative algorithm. We present our protocol for this situation, the HVPG measurement procedure, and the results of our cohort. MATERIAL AND METHODS: We performed a retrospective statistical analysis of all patients who underwent planned hepatic resection for HCC with HVPG measurement between 1/2016 and 1/2023. The cohort included 35 patients (30 males, mean age 69.5 years) who underwent HVPG measurement before liver resection for HCC. RESULTS: The success rate of measurement was 91.4%, with serious complications in 2.9% of cases. Due to the clinically significant portal hypertension (CSPH) 31.3% of patients were rejected for resection. Seventeen patients with excluded CSPH underwent resection with one case of a postoperative liver event, liver decompensation, representing 5.9% of them. One patient (5.9%) had a complicated postoperative course with fasciitis. None of the patients who underwent resection (88.2%) was readmitted to the hospital due to surgical complications or a liver event during 90 days of follow-up, and no death was reported. The median overall survival (OS) in the resected subgroup was 70 months (95% CI: 52-86), and in patients rejected for surgery (resection and transplantation) 35 months (95% CI: 13-48). CONCLUSIONS: HVPG measurement is the gold standard for the quantification of portal hypertension. Hepatic vein catheterization is invasive, but a safe procedure, with a clear impact on the management of resectable HCC.

Clinic of Oncology 1 Faculty of Medicine Charles University Thomayer University Hospital Prague Praha Czech Republic

Department of Medicine 1 Faculty of Medicine Charles University and Military University Hospital Prague Praha Czech Republic

Department of Medicine Faculty of Military Health Sciences University of Defense Hradec Králové Czech Republic

Department of Radiodiagnostic Military University Hospital Prague Praha Czech Republic

Department of Surgery 2 Faculty of Medicine Charles University and Military University Hospital Prague Praha Czech Republic

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Burroughs AK, Groszmann R, Bosch J, et al. . Assessment of therapeutic benefit of antiviral therapy in chronic hepatitis C: is hepatic venous pressure gradient a better end point? Gut 2002; 50: 425-427. PubMed PMC

Abraldes JG, Villanueva C, Banares R, et al. . Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy. J Hepatol 2008; 48: 229-236. PubMed

Moitinho E, Escorsell A, Bandi JC, et al. . Prognostic value of early measurements of portal pressure in acute variceal bleeding. Gastroenterology 1999; 117: 626-631. PubMed

Ripoll C, Groszmann RJ, Garcia-Tsao G, et al. . Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol 2009; 50: 923-928. PubMed PMC

European Association For The Study Of The Liver, European Organisation For Research and Treatment of Cancer . EASLEORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56: 908-943. PubMed

Citterio D, Facciorusso A, Sposito C, et al. . Hierarchic interaction of factors associated with liver decompensation after resection for hepatocellular carcinoma. JAMA Surg 2016; 151: 846-853. PubMed

Roayaie S, Jibara G, Tabrizian P, et al. . The role of hepatic resection in the treatment of hepatocellular cancer. Hepatology 2015; 62: 440-451. PubMed

European Association for the Study of the Liver; European Association for the Study of the Liver . EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018; 69: 182-236. PubMed

Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999; 19: 329-338. PubMed

Bosch J, Mastai R, Kravetz D, et al. . Hemodynamic evaluation of the patient with portal hypertension. Semin Liver Dis 1986; 6: 309-317. PubMed

Kusminsky RE. Complications of central venous catheterization. J Am Coll Surg 2007; 204: 681-696. PubMed

Polderman KH, Girbes AJ. Central venous catheter use. Part 1: mechanical complications. Intensive Care Med 2002; 28: 1-17. PubMed

de Franchis R, Bosch J, Garcia-Tsao G, et al. . Baveno VII–Rene-wing consensus in portal hypertension. J Hepatol 2022; 76: 959-974. PubMed PMC